Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial
| Autor: | RA Dyer, D. van Dyk, A. Emmanuel, M F M James, A.R. Reed, A. Daniels, Carl Lombard, M.J. Arcache, S. Schulein, A. Vorster |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Cardiac output Cardiac index Mothers Anesthesia Spinal 03 medical and health sciences Phenylephrine 0302 clinical medicine Pre-Eclampsia 030202 anesthesiology Pregnancy Heart rate medicine Anesthesia Obstetrical Humans Vasoconstrictor Agents 030212 general & internal medicine Colloids Ephedrine Cardiac Output business.industry Cesarean Section Stroke volume Preload Anesthesiology and Pain Medicine medicine.anatomical_structure Anesthesia Vascular resistance Female Hypotension business medicine.drug |
| Zdroj: | Anaesthesia. 73(1) |
| ISSN: | 1365-2044 |
| Popis: | We examined the haemodynamic effects of colloid preload, and phenylephrine and ephedrine administered for spinal hypotension, during caesarean section in 42 women with severe early onset pre-eclampsia. Twenty patients with pre-delivery spinal hypotension were randomly allocated to receive an initial dose of either 50 μg phenylephrine or 7.5 mg ephedrine; the primary outcome was percentage change in cardiac index. After a 300-ml colloid preload, mean (SD) cardiac index increased from 4.9 (1.1) to 5.6 (1.2) l.min-1 .m-2 (p 10% and > 5%, respectively; a significant negative correlation was found between heart rate and stroke volume changes. Spinal hypotension in 20 patients was associated with an increase from baseline in cardiac index of 0.6 l.min-1 .m-2 (mean difference 11.5%; p < 0.0001). After a median [range] dose of 50 [50-150] μg phenylephrine or 15 [7.5-37.5] mg ephedrine, the percentage change in cardiac index during the measurement period of 150 s was greater, and negative, in patients receiving phenylephrine vs. ephedrine, at -12.0 (7.3)% vs. 2.6 (6.0)%, respectively (p = 0.0001). The percentage change in heart rate after vasopressor was higher in patients receiving phenylephrine, at -9.1 (3.4)% vs. 5.3 (12.6)% (p = 0.0027), as was the change in systemic vascular resistance, at 22.3 (7.5) vs. -1.9 (10.5)% (p < 0.0001). Phenylephrine effectively reverses spinal anaesthesia-induced haemodynamic changes in severe pre-eclampsia, if left ventricular systolic function is preserved. |
| Databáze: | OpenAIRE |
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