Document Detail

Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study.
MedLine Citation:
PMID:  16116005     Owner:  NLM     Status:  MEDLINE    
In this randomized, multicenter study we compared the hemodynamic effects of spinal and epidural anesthesia for cesarean delivery in severely preeclamptic patients. The epidural group (n = 47) received 2% lidocaine with epinephrine 1:400,000, 18-23 mL, followed by 3 mg of morphine after delivery. The spinal group (n = 53) received 2.2 mL of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. We hypothesized that the lowest MAP (mean arterial blood pressure, the primary outcome) during the delivery period would have to be at least 10 mm Hg less in the spinal group to be of clinical importance. We found that there was a statistically significant difference in MAP, with more patients in the spinal group exhibiting hypotension (P < 0.001). Although the incidence of hypotension (systolic arterial blood pressure, SAP < or =100 mm Hg) was more frequent in the spinal group than in the epidural group (51% versus 23%), the duration of significant hypotension (SAP < or =100 mm Hg) was short (< or =1 min) in both groups. There was more use of ephedrine in the spinal group than in the epidural group (median, 6 versus 0 mg) but hypotension was easily treated in all patients. Neonatal outcomes assessed by Apgar scores and the umbilical arterial blood gas analysis were similar in both groups. Adverse neonatal outcomes (5-min Apgar score < 7 and umbilical arterial blood pH < 7.20) were found in only 2 premature newborns (weight < 1500 g) who were born without maternal hypotension after regional anesthesia. We conclude that the results of this large prospective study support the use of spinal anesthesia for cesarean delivery in severely preeclamptic patients.
Shusee Visalyaputra; Oraluxna Rodanant; Wanna Somboonviboon; Kamthorn Tantivitayatan; Somboon Thienthong; Wanawimol Saengchote
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
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:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-8, table of contents     Citation Subset:  AIM; IM    
Department of Anesthesiology, Siriraj Hospital, Bangkoknoi, Bangkok 10700, Thailand.
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MeSH Terms
Anesthesia, Epidural*
Anesthesia, Obstetrical*
Anesthesia, Spinal*
Apgar Score
Birth Weight / physiology
Blood Gas Analysis
Blood Pressure / physiology
Cesarean Section*
Double-Blind Method
Hemodynamics / drug effects,  physiology
Infant, Newborn
Pre-Eclampsia / physiopathology*
Comment In:
Anesth Analg. 2006 Dec;103(6):1584; author reply 1584-5   [PMID:  17122251 ]
Anesth Analg. 2005 Sep;101(3):859-61   [PMID:  16116004 ]

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