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Cesarean section; cardiac output; hypotension

S Orbach-Zinger, E Razinsky, I Bizman, S Firman, R Gat, A Davis, E Ashwal, A Shmueli, M Vaturi, R Gabbay-Benziv, L A Eidelman
INTRODUCTION: Spinal anesthesia is considered the gold standard anesthetic technique for cesarean deliveries (CD) but is associated with a high rate of hypotension. The recent international consensus recommends continuous prophylactic phenylephrine infusion (PPI) administered throughout CD to prevent hypotension. However little information is available on the hemodynamic profiles of women with twin pregnancies as compared to singleton pregnancies perioperatively. Therefore, in this study we aim we compare maternal hemodynamic changes both intraoperatively and postoperatively with the use of the NICAS bio impendence monitor in healthy singleton versus twin parturients undergoing CD deliveries with spinal anesthesia with PPI...
May 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
Feride Karacaer, Ebru Biricik, İlker Ünal, Selim Büyükkurt, Hakkı Ünlügenç
PURPOSE: Spinal anesthesia-induced hypotension (SAIH) during cesarean delivery is not rare and frequently leads to materno-fetal discrepancy and collapse. More recently, norepinephrine has been proposed for the prevention and treatment of SAIH with fewer tendencies to decrease heart rate and cardiac output. Ondansetron has been reported to reduce the incidence of SAIH in patients undergoing cesarean section. The aim of the present study was to assess the effect of prophylactic ondansetron on the incidence of SAIH, norepinephrine consumption, and adverse effects...
February 2018: Journal of Anesthesia
W Mon, A Stewart, R Fernando, K Ashpole, N El-Wahab, S MacDonald, P Tamilselvan, M Columb, Y M Liu
Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions...
February 2017: Journal of Clinical Anesthesia
Venu Jain, Radha Chari, Sharon Maslovitz, Dan Farine, Emmanuel Bujold, Robert Gagnon, Melanie Basso, Hayley Bos, Richard Brown, Stephanie Cooper, Katy Gouin, N Lynne McLeod, Savas Menticoglou, William Mundle, Christy Pylypjuk, Anne Roggensack, Frank Sanderson
OBJECTIVE: Physical trauma affects 1 in 12 pregnant women and has a major impact on maternal mortality and morbidity and on pregnancy outcome. A multidisciplinary approach is warranted to optimize outcome for both the mother and her fetus. The aim of this document is to provide the obstetric care provider with an evidence-based systematic approach to the pregnant trauma patient. OUTCOMES: Significant health and economic outcomes considered in comparing alternative practices...
June 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
S Toyama, M Kakumoto, M Morioka, K Matsuoka, H Omatsu, Y Tagaito, T Numai, M Shimoyama
BACKGROUND: Hypotension during spinal anaesthesia for Caesarean delivery is a result of decreased vascular resistance due to sympathetic blockade and decreased cardiac output due to blood pooling in blocked areas of the body. Change in baseline peripheral vascular tone due to pregnancy may affect the degree of such hypotension. The perfusion index (PI) derived from a pulse oximeter has been used for assessing peripheral perfusion dynamics due to changes in peripheral vascular tone. The aim of this study was to examine whether baseline PI could predict the incidence of spinal anaesthesia-induced hypotension during Caesarean delivery...
August 2013: British Journal of Anaesthesia
Le Li, Yang Zhang, Ying Tan, Shiyuan Xu
AIM: To compare the effect of colloid and crystalloid on maternal and neonatal hemodynamics in cesarean section. MATERIAL AND METHODS: We searched MEDLINE (PubMed, 1966-2011), EMBASE (1974-2011),, the Cochrane Controlled Clinical Trials Register Database, Biosis Preview, and the Chinese Biomedical Database (1980-2011). Randomized controlled trials involving healthy term patients undergoing scheduled cesarean delivery that compared the effect of colloid and crystalloid on hypotension, need for vasopressors, cardiac output, neonatal outcomes, and other adverse effects were analyzed...
May 2013: Journal of Obstetrics and Gynaecology Research
Anne Doherty, Yayoi Ohashi, Kristi Downey, Jose C A Carvalho
INTRODUCTION: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. The optimal administration regimen is undetermined. We used a Non-invasive cardiac output monitor to test the hypothesis that a fixed-rate phenylephrine infusion regimen would cause a smaller reduction in maternal cardiac output, and result in less maternal hypotension, as compared to a phenylephrine bolus regimen. METHODS: This was a double-blind, randomized clinical trial of women undergoing elective cesarean delivery under spinal anesthesia...
December 2012: Anesthesia and Analgesia
Christian Loubert
PURPOSE: The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. PRINCIPAL FINDINGS: Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension...
June 2012: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
David W Cooper
PURPOSE OF REVIEW: This review assesses the maternal and fetal effects of vasopressor administration during spinal anaesthesia for caesarean delivery, with emphasis on recent findings. RECENT FINDINGS: Maternal heart rate is a good surrogate for cardiac output. The initial hypotensive effect of spinal anaesthesia is caused by a rapid decrease in systemic vascular resistance, which makes α-agonists the logical first-line therapy. Effective prophylactic phenylephrine administration can be associated with reduced maternal cardiac output, but this has not been associated with adverse maternal or fetal effects...
June 2012: Current Opinion in Anaesthesiology
Ashraf S Habib
Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. This review highlights the effects of phenylephrine compared with ephedrine on maternal hemodynamics (arterial blood pressure, heart rate, and cardiac output), and occurrence of intraoperative nausea and vomiting...
February 2012: Anesthesia and Analgesia
Frédéric J Mercier
No abstract text is available yet for this article.
October 2011: Anesthesia and Analgesia
Sarah McDonald, Roshan Fernando, Keri Ashpole, Malachy Columb
BACKGROUND: Minimizing hypotension associated with spinal anesthesia for cesarean delivery by administration of IV fluids and vasopressors reduces fetal and maternal morbidity. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) variables in parturients receiving a phenylephrine infusion combined with the rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload)...
October 2011: Anesthesia and Analgesia
Anne Doherty, Yayoi Ohashi, Kristi Downey, Jose C A Carvalho
BACKGROUND AND OBJECTIVES: Blood pressure monitoring offers a limited understanding of the hemodynamic consequences of spinal anesthesia for cesarean delivery. The purpose of this study was to assess, with the aid of a non-invasive cardiac output monitor based on bioreactance, the hemodynamic changes during elective cesarean delivery under spinal anesthesia in which intermittent boluses of phenylephrine were used to prevent and treat hypotension. METHODS: This observational study was conducted with the Research Ethics Board approval, and all participants provided written informed consent...
May 2011: Revista Brasileira de Anestesiologia
Robert A Dyer, Anthony R Reed
No abstract text is available yet for this article.
November 2010: Anesthesia and Analgesia
Adrienne Stewart, Roshan Fernando, Sarah McDonald, Rachel Hignett, Tanya Jones, Malachy Columb
BACKGROUND: Hypotension is the most common serious side effect of spinal anesthesia for cesarean delivery. There has been a move recently toward the use of phenylephrine as a vasopressor infusion to improve maternal cardiovascular stability and fetal outcome. Although it seems safe in the elective setting, there have been concerns about its propensity for causing an increase in afterload and a baroreceptor-mediated bradycardia in the mother, with a consequent reduction in maternal cardiac output (CO)...
November 2010: Anesthesia and Analgesia
José Otavio Costa Auler, Marcelo L A Torres, Mônica M Cardoso, Thais C Tebaldi, André P Schmidt, Mario M Kondo, Marcelo Zugaib
BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed...
June 2010: Clinics
Perumal Tamilselvan, Roshan Fernando, Johanna Bray, Manisha Sodhi, Malachy Columb
BACKGROUND: Hypotension after spinal anesthesia for cesarean delivery remains a major clinical problem. Fluid preloading regimens together with vasopressors have been used to reduce its incidence. Previous studies have used noninvasive arterial blood pressure measurement and vasopressor requirements to evaluate the effect of preload. We used a suprasternal Doppler flow technique to measure maternal cardiac output (CO) and corrected flow time (FTc, a measure of intravascular volume) before and after spinal anesthesia after 3 fluid preload regimens...
December 2009: Anesthesia and Analgesia
Arnab Banerjee, Renato M Stocche, Pamela Angle, Stephen H Halpern
BACKGROUND: Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome...
January 2010: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Robert A Dyer, Anthony R Reed, Dominique van Dyk, Michelle J Arcache, Owen Hodges, Carl J Lombard, Jaime Greenwood, Michael F James
BACKGROUND: Hemodynamic responses to vasopressors used during spinal anesthesia for elective Cesarean delivery, have not been well described. This study compared the effects of bolus phenylephrine and ephedrine on maternal cardiac output (CO). The hypothesis was that phenylephrine, but not ephedrine, decreases CO when administered in response to hypotension during spinal anesthesia. METHODS: Forty-three patients were randomized to receive 80 microg of phenylephrine or 10 mg of ephedrine...
October 2009: Anesthesiology
Wendy H L Teoh, Alex T H Sia
BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension, and a decrease in cardiac output (CO) and blood flow to the placenta. Fluid preloading with crystalloid is ineffective due to rapid redistribution. A "coload" given at the time of cerebrospinal fluid identification may be more effective. Our null hypothesis was that there would be no difference between the effect of a colloid preload (15 mL/kg hydroxyethyl starch (HES) 130/0.4 [Voluven 6%]) and an identical coload on maternal CO and the incidence of hypotension after spinal anesthesia for cesarean delivery...
May 2009: Anesthesia and Analgesia
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