Document Detail


Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery.
MedLine Citation:
PMID:  16116006     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We previously showed that, in comparison with term healthy parturients, patients with severe preeclampsia had a less frequent incidence of spinal hypotension, which was less severe and required less ephedrine. In the present study, we hypothesized that these findings were attributable to preeclampsia-associated factors rather than to a smaller uterine mass. The incidence and severity of hypotension were compared between severe preeclamptics (n = 65) and parturients with preterm pregnancies (n = 71), undergoing spinal anesthesia for cesarean delivery (0.5% bupivacaine, sufentanil, morphine). Hypotension was defined as the need for ephedrine (systolic blood pressure <100 mm Hg in parturients with preterm fetuses or 30% decrease in mean blood pressure in both groups). Apgar scores and umbilical arterial blood pH were also studied. Neonatal and placental weights were similar between the groups. Hypotension was less frequent in preeclamptic patients than in women with preterm pregnancies (24.6% versus 40.8%, respectively, P = 0.044). Although the magnitude of the decrease in systolic, diastolic, and mean arterial blood pressure was similar between groups, preeclamptic patients required less ephedrine than women in the preterm group to restore blood pressure to baseline levels (9.8 +/- 4.6 mg versus 15.8 +/- 6.2 mg, respectively, P = 0.031). The risk of hypotension in the preeclamptic group was almost 2 times less than that in the preterm group (relative risk = 0.603; 95% confidence interval, 0.362-1.003; P = 0.044). The impact of Apgar scores was minor, and umbilical arterial blood pH was not affected. We conclude that preeclampsia-associated factors, rather than a smaller uterine mass, account for the infrequent incidence of spinal hypotension in preeclamptic patients.
Authors:
Antoine G M Aya; Nathalie Vialles; Issam Tanoubi; Roseline Mangin; Jean-Michel Ferrer; Colette Robert; Jacques Ripart; Jean-Emmanuel de La Coussaye
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  101     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-23     Completed Date:  2005-09-27     Revised Date:  2006-12-07    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  869-75, table of contents     Citation Subset:  AIM; IM    
Affiliation:
Fédération Anesthésie-Douleur-Urgences-Réanimation, GHU Caremeau, Place du Pr Robert Debré, 30029 Nîmes cedex 9, France. guy.aya@chu-nimes.fr
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Obstetrical / adverse effects*
Anesthesia, Spinal / adverse effects*
Apgar Score
Birth Weight
Blood Pressure / drug effects
Cesarean Section*
Ephedrine / therapeutic use
Female
Fetal Blood / metabolism,  physiology
Heart Rate / drug effects
Humans
Hydrogen-Ion Concentration
Hypotension / chemically induced*,  drug therapy
Infant, Newborn
Obstetric Labor, Premature / complications,  physiopathology*
Pre-Eclampsia / complications,  physiopathology*
Pregnancy
Risk Assessment
Tocolysis
Vasoconstrictor Agents / therapeutic use
Chemical
Reg. No./Substance:
0/Vasoconstrictor Agents; 299-42-3/Ephedrine
Comments/Corrections
Comment In:
Anesth Analg. 2005 Sep;101(3):859-61   [PMID:  16116004 ]
Anesth Analg. 2006 Dec;103(6):1584; author reply 1584-5   [PMID:  17122251 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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