Effect of the menstrual cycle on circulation during combined spinal-epidural anaesthesia

Hemodynamic stability during menstrual cycle in women undergoing elective surgery

Objective

Hemodynamic changes occur in almost one-third of patients undergoing spinal anesthesia, which are likely to effect vital organ. The aim of this study is to determine the hemodynamic effect of spinal anesthesia during different phases of menstrual cycle.

Methods

This is a descriptive cross-sectional study, two hundred and seventy-three patients who underwent spinal anesthesia for elective surgery were enrolled in this study. Of all the patients, 141 patients were in the luteal phase and 132 patients were in the follicular phase of their menstrual cycle. Analytical epidemiological study was conducted using questionnaires. Blood pressure and heart rate of patients before, immediately after, and 1 h after spinal anesthesia were recorded, and the data were analyzed using SPSS software.

Results

In the follicular phase before anesthesia, systolic blood pressure (SBP) was 127.5 ± 3.9, diastolic blood pressure (DBP) was 80.3 ± 6.2 mmHg and heart rate (HR) was 82.0 ± 8.5bpm, while, immediately after the induction of anesthesia following recordings were measured; 109.7 ± 9.13, 71.8 ± 2.8 mmHg and 70.0 ± 8.10bpm, respectively. In the luteal phase, it was 126.9 ± 3.12, 81.6 ± 9.3 mmHg and 80.2 ± 4.4bpm, and 122.0 ± 9.12, 78.6 ± 8.5 mmHg and 75.9 ± 6.5bpm respectively before and immediately after anesthesia, these changes in the menstrual phase was significant (P < 0.001). In the follicular phase an hour after spinal anesthesia, the mean SBP was 100.3 ± 3.9, DBP was 71.2 ± 7.5, MAP was 87.0 ± 4.7 mmHg and HR 67.5 ± 5.7bpm and following was seen in luteal phase; 115.4 ± 1.8, 75.9 ± 2.3, 97.3 ± 3.5 mm Hg and 74.0 ± 7.4bpm, respectively. These values were significantly lower in the follicular phase (P < 0.001).

Conclusion

Spinal anesthesia in the luteal phase as compared to the follicular phase of the menstrual cycle shows less variation in hemodynamic parameters.

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Hemodynamic changes occur in almost one-third of patients undergoing spinal anesthesia.

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Spinal anesthesia in the luteal phase as compared to the follicular phase of the menstrual cycle.

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Our study did not measure the levels of progesterone and estrogen.

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Comparative studies including women with circulatory abnormalities, preoperative and postoperative analysis.

Is menstruation a valid reason to postpone cardiac surgery?

Background:

Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.

Aims:

The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.

Settings and Design:

A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.

Patients and Methods:

The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.

Results:

The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).

Conclusion:

Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.