Comparison of spread of subarachnoid sensory block and incidence of hypotension in early and late second trimester of pregnancy

Correlation between gestational age and level of sensory block in spinal anesthesia

BACKGROUND AND OBJECTIVES

To identify a specific correlation between progression of gestational age and level of sensory block in spinal anesthesia in patients undergoing cervical cerclage.

METHODS

The medical records of patients who underwent cervical cerclage under spinal anesthesia using hyperbaric bupivacaine between March 2016 and May 2018 were retrospectively reviewed. The primary outcome measure was the correlation between gestational age and sensory block level of spinal anesthesia. Secondary outcomes included the correlations between gestational age and reduction in blood pressure and length of the postanesthesia care unit (PACU) stay. The Pearson correlation test, partial correlation test, and linear regression were used to identify relationships and to adjust for confounding variables.

RESULTS

Of the 261 cases reviewed, there was a linear and significant correlation between gestational age and sensory block level, reduction in systolic blood pressure during surgery, reduction in systolic blood pressure during PACU, and length of PACU stay, after adjusting for confounding factors (partial correlation coefficient=0.71, p<0.001; 0.27, p<0.001; 0.25, p<0.001; 0.21, p=0.001, respectively). A 1-day increase in gestational age corresponded to an increase of 0.04 dermatomes in sensory block level (95% CI 0.035 to 0.045, p<0.001).

CONCLUSION

Results demonstrated that as the gestational age progressed, sensory block level increased, blood pressure was decreased, and length of PACU stay increased after spinal anesthesia. Sensory block increased by 0.28 dermatomes when the pregnancy progressed 1 week. Further controlled prospective studies are needed to support this relationship.

TRIAL REGISTRATION NUMBER

KCT0000538.

Obstetric anesthesia: not just for cesareans and labor

The scope of obstetric anesthesia practice ranges far beyond the delivery of care to women for vaginal and cesarean deliveries. Increasingly, obstetric anesthesiologists are involved in the management of anesthetics for new procedures and for new indications. Anesthesia is frequently needed for maternal procedures, as well as fetal procedures, and at varying times in the intrapartum period. Maternal-specific procedures include cerclage, external cephalic version (ECV), postpartum bilateral tubal ligation (BTL), and dilation and evacuation (D and E). Fetus-specific procedures include fetoscopic laser photocoagulation and ex-utero intrapartum treatment (EXIT). This review will not include discussion of the anesthetic management of non-obstetric surgery during pregnancy, such as appendectomy or cholecystectomy.