Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing

Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing

Authors

  • Michele Zasa
  • Eleonora Conci
  • Alessandro Marchignoli
  • Rita Pini
  • Lorenzo Passeri
  • Guido Fanelli
  • Andrea Cornini

Keywords:

anesthesia, spinal, complication, hypotension, Cesarean section, neonatal outcome, ephedrine

Abstract

Background: Maternal hypotension during spinal anaesthesia for Caesarean delivery is a common event, with potential detrimental consequences. We led a prospective, randomized study to compare the effects of two strategies on neonatal and maternal wellbeing. Methods: Parturients scheduled for elective Caesarean section in spinal anaesthesia were preoperatively studied with a supine stress test. Those with a positive test were enrolled in the study and received a solution of 0.5% hyperbaric bupivacaine 12.5 mg and 0.02% morphine 200 µg intrathecally. Patients received a 37.5 mg/h preventive intravenous (IV) infusion of ephedrine (Pharmacologic Group), or a 15° left lateral tilt (Non-Pharmacologic Group). In Pharmacolgic Group hypotension was treated for 20% drops in systolic blood pressure; in Non-Pharmacolgic Group only severe hypotension – defined as a 40% drop in systolic blood pressure – was treated. Results: Thirty-six patients were studied. Study groups were statistically similar in terms of demographic variables and intraoperative times. No statistical differences were found in terms of umbilical arterial blood base excess [-1.4 (-3.7 to -0.3) mEq/l Pharmacologic Group vs. -1.7 (-2.7 to -1.0) mEq/l Non-Pharmacologic Group; p=0.815] and other umbilical blood gas values. Apgar scores were statistically similar between study groups. Treatment for hypotension was required by 13 (72.2%) patients in Pharmacologic Group and 9 (50%) patients in Non-Pharmacologic Group (p=0.171). No differences were found at the analysis of serial changes in vital signs. Conclusions: Both studied strategies guaranteed a comparable safe outcome in terms of maternal and neonatal wellbeing. (www.actabiomedica.it)

Author Biographies

Michele Zasa

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)- 

Clinica Mobile nel Mondo, World Motorbike Championship (MotoGP & WSBK) Medical Division, Parma, Italy

Eleonora Conci

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Alessandro Marchignoli

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Rita Pini

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Lorenzo Passeri

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Guido Fanelli

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

Andrea Cornini

Department of Anaesthesiology, Intensive Care and Pain Medicine - University Hospital of Parma, Parma (Italy)-

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Published

27-04-2015

Issue

Section

ORIGINAL ARTICLES

How to Cite

1.
Zasa M, Conci E, Marchignoli A, Pini R, Passeri L, Fanelli G, et al. Comparison of two different approaches to hypotension following spinal anaesthesia for Caesarean delivery: effects on neonatal and maternal wellbeing. Acta Biomed [Internet]. 2015 Apr. 27 [cited 2024 Jul. 26];86(1):45-52. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/4192