The effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic changes post spinal anesthesia for elective cesarean delivery: A prospective cohort study

English version

Autoři: Shamill Eanga Helill ^aff001; Wossenyeleh Admasu Sahile ^aff002; Ritbano Ahmed Abdo ^aff003; Getahun Dendir Wolde ^aff004; Hassen Mosa Halil ^aff003
Působiště autorů: Department of Anesthesia,College of Medicine and Health Sciences,Wachemo University, Hossana, Ethiopia ^aff001; Department of Anesthesia, School of Medicine, Addis Ababa University Addis, Addis Ababa, Ethiopia ^aff002; Department of Midwifery,College of Medicine and Health Sciences,Wachemo University, Hossana, Ethiopia ^aff003; Department of Anesthesia, School of Medicine, Wolaita Sodo University, Wolaita, Ethiopia ^aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226030

Souhrn

Background

Spinal anesthesia is a form of regional anesthesia frequently used in various lower abdominal, orthopedic, obstetric operations such as a cesarean delivery. The most common local anesthetic used for spinal anesthesia in obstetric and non-obstetric surgery is bupivacaine which can be utilized as an isobaric or hyperbaric solution, producing differences in maternal hemodynamic changes. Against this backdrop, the study aims to compare the effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic alterations after administering spinal anesthesia for elective cesarean delivery at Gandhi Memorial Hospital, Addis Ababa, Ethiopia.

Methods

A hospital-based prospective cohort study design was employed for the period December 1, 2017 to January 30, 2018. A total of 100 parturient were involved, with one group exposed to isobaric bupivacaine and the other to hyperbaric bupivacaine to observe their effects on maternal hemodynamic changes post spinal anesthesia. The participants were selected through systematic random sampling. Data analysis was performed using SPSS (version 20) through descriptive statistic, independent sample t-test, Mann-Whitney U-test, Fisher’s exact test, and Chi-square test were used. P values of <0.05 was assumed as statistically significant for all tests.

Results

The incidence of hypotension was found to be greater in isobaric than hyperbaric groups (82% vs. 60% respectively; p = 0.015). No statistical significant differences were found in mean arterial pressure value at baseline, but, statistically significant changes were observed among the groups (p <0.05) at all study timing after spinal anesthesia, except at 30^thmin. No statistically significant differences were seen in the mean heart rate variability after spinal anesthesia at all periods, except the 15th minute (p = 0.033). A greater rate of vasopressor was used in the isobaric group as compared to the hyperbaric group (36% vs. 14% respectively; p = 0.011).

Conclusion

Baricity is a significant factor in maternal hemodynamic changes in the parturient for elective cesarean section. Isobaric bupivacaine produces greater change in blood pressure and incidence of hypotension and entails a greater vasopressor requirement than hyperbaric bupivacaine after spinal anesthesia for elective cesarean section.

Klíčová slova:

Obstetrics and gynecology – Blood pressure – Hemodynamics – Data processing – Anesthesia – Local and regional anesthesia – Cesarean section – Hypotension

Zdroje

1. Wong JO, Tan TD, Leung P, Tseng K, Cheu N. Comparison of the effect of two differentdoses of 0.75% glucose-free ropivacaine forspinal anesthesia for lower limb and lower abdominal surgery. Kaohsiung J Med Sci 2004 20 9.

2. Urmey WF. Spinal anaesthesia for outpatient surgery. Best Pract Res Clin Anaesthesiol 2003;17:335–46. doi: 10.1016/s1521-6896(03)00015-6 14529006

3. Iohom BDODG. Regional anesthesia techniques for ambulatory orthopedic surgery. doi: 10.1097/aco.0b013e328314b665 19009687. 2008;21(6):723–8.

4. Stamer UM, Stüber F, Wulf H, Meuser T. Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand. 2005 49(2):170–6. doi: 10.1111/j.1399-6576.2004.00583.x 15715617

5. Birnbach DJ. Anesthesia for obstetrics. In: Miller RD, editor. Miller’s anesthesia.Philadelphia: Churchill Livingstone;. European Journal of Anaesthesiology (EJA). 2010.;31 (188):2203–40.

6. Chestnut D, Wong C, Tsen L, Beilin Y, Mhyre J. Chestnut’s obstetric anesthesia: Principles and practice. Philadelphia:ELSCIER. 2009:4th ed.

7. Solakovic N. Comparison of Hemodynamic Effects ofHyperbaric and Isobaric Bupivacaine in SpinalAnesthesia. MED ARH. 2010; 64(1):11–4 20422816

8. Ayorinde BT, Buczkowski P, Brown J, Shah J, Buggy DJ. Evaluation of pre-emptive intramuscular phenylephrine and ephedrine for reduction of spinal anaesthesia-induced hypotension during Caesarean section. Br J Anaesth. 2001; 86:372–6. doi: 10.1093/bja/86.3.372 11573527

9. Hussain MD, Mallick MT. Effects of isobaric bupivacaine in endoscopic urological surgeries under spinal anaesthesia. JAFMC Bangladesh. 2011; 7:33–6.

10. Loubert CF, Hallworth S, Fernando R, Columb MF, Patel N, Sarang K, et al. Does the Baricity of Bupivacaine Influence IntrathecalSpread in the Prolonged Sitting Position BeforeElective Cesarean Delivery?. A Prospective Randomized Controlled Study. www.anesthesia-analgesia.org. 2011 113 4. doi: 10.1213/ANE.0b013e3182288bf2 21890887

11. Danelli G, Di Cianni S, ZasaM md, De Marco G, Adamanti S. Effects of baricity of 0.5% or 0.75%levobupivacaine on the onset time of spinalanesthesia: a randomized trial. AN J ANESTH 2008;55: 8.

12. Malinovsky J-M, Renaud G, Corre PL, Pharm D, Charles FS, Malinge M, et al. Intratbecal Bupiuacaine in HumansInfluence of Volume and Baricity of Solutions. Anesthesiology. 1999;9I(1260–6).

13. Wason R. Comparison of hypobaric, near isobaric andhyperbaric bupivacaine for spinal anaesthesiain patients undergoing knee arthroscopy. wason, gogia,. ahni;rupa:445–8: comp.

14. Richardson MG, Wissler RN. Intrathecal hypobaric versus hyperbaric bupivacaine with morphine for cesarean section. Anesth Analg 1998;87: 336–40. doi: 10.1097/00000539-199808000-00019 9706927

15. Bigler D MI, Hjortso N-C. Double-blind evaluation of intrathecal hyperbaric and glucose-free bupivacaine on analgesia and cardiovascular function. Reg Anesth 1986;11:151–5.

16. Ehrenfeld JM, Urman RD. Segal S Anesthesia Student Survival Guide. A Case-Based Approach. Switzerland: Springer International Publishing 2016:2nd ed. doi: 10.1007/978-3-319-11083-7

17. Naz F, Begum A, Malik M, Zareen A. Complication of Spinal Anaesthesia in Caesarean Section. Pakistan Journal of Medical and Health Sciences 2010;4:3.

18. Singh M, Shamsah M. Influence of injection rate of hyperbaric bupivacaine on spinal block in parturients: a randomizedtrial. CAN J ANESTH. 2007 54 (4):290–5. doi: 10.1007/BF03022774 17400981

19. Brenck F, Katzer C, Obaid R, Brüggmann D, Benson M, Röhrig R, Junger A. Hypotension after spinal anesthesia for cesarean section: identifcation of risk factors using an anesthesia information management system. Journal of clinical monitoring and computing 2009;23:85–92. doi: 10.1007/s10877-009-9168-x 19277879

20. Hartmann B, Klasen J, Benson M, Jost A, Banzhaf A, Hempelmann G. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg 2002;94: 1521–9. doi: 10.1097/00000539-200206000-00027 12032019

21. Atef K. Salama HMG, Bassant M. Abdel Hamid. Fluid preloading versus ephedrine in the management of spinalanesthesia-induced hypotension in parturients undergoingcesarean delivery: a comparative study. Ain-Shams Journal of Anesthesiology 2016; 9:72–5.

22. Siddik-Sayyid SMM, Viviane G, Samar, Zbeide RAMS K., Jules-Marie A. Alami Al, et al. A Randomized Trial Comparing Colloid Preload to Coload During Spinal Anesthesia for Elective CesareanDelivery. October 2009 109 (4):1219–24. doi: 10.1213/ane.0b013e3181b2bd6b 19641050

23. Atashkhoei SM, Abedini NM, Pourfathi HM, Bahrami AZ, Hatami PM. Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial. Iran J Med Sci. 2017;42: 2.

24. Aftab HA S., Zafar S.et.al. intrathecal isobaric versus hyperbaric bupivacaine for ellective cesarean section. Pakistan journal of Surgery. 2007;23(4).

25. Toptaş M, Uzman S, İşitemiz İ, Yanaral TU, Akkoç İ, Bican G. A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability. Turkish Journal of Medical Sciences 2014; 44: 224–231. doi: 10.3906/sag-1207-1 25566589

26. Hallworth S, Roshan F, Columb MO. The Effect of Posture and Baricity on the Spread of Intrathecal Bupivacaine for Elective Cesarean Delivery. Obstetric Anesthesia: Research Report. 2005; 100 (4): 1159–65.

27. Critchley LA, Derrick J. The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%. 1999;54:469–74. doi: 10.1046/j.1365-2044.1999.00841.x 10995146

28. Helmi M, Uyun Y, Suwondo BS, and Widodo U. Comparison of intrathecal use of isobaric and hyperbaric bupivacaine during lower abdomen surgery. J Anesthesiol 2014. 2014:1–4.