Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section

Atanas Sivevski; Emilija Ivanov; Dafina Ðšaradjova; Maja Slaninka-Miceska; Igor Kikerkov

doi:10.3889/oamjms.2019.230

Authors

Atanas Sivevski University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Emilija Ivanov University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Dafina Ðšaradjova University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Maja Slaninka-Miceska Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
Igor Kikerkov Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2019.230

Keywords:

Preeclampsia, Cesarean section, Spinal anaesthesia, Low-dose, Hypotension

Abstract

BACKGROUND: There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients.

METHODS: Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Spinal anaesthesia was performed with a mixture of 8-9 mg isobaric 0.5% bupivacaine, 20 mcg fentanyl and 100 mcg morphine (total volume 2.2-2.4 ml). Blood pressures (BP)-SBP, DBP, MAP were recorded non-invasively before performing spinal anaesthesia and at 2.5 minutes after a spinal puncture.

RESULTS: The BP falls (%) from baseline were significantly greater in the healthy parturients compared to those with preeclampsia (25.8% Â± 10.1 vs 18.8% Â± 17.0 for SBP, 28.5% Â± 8.8 vs 22.5% Â± 10.4 for DBP, and 31.2% Â± 14.2 vs 18.2% Â± 12.6% for MAP, p < 0.05). The incidence rate of hypotension in the preeclamptics was 25% compared to 53% in healthy parturients (p < 0.001). Higher doses of vasopressors both ephedrine (16.5 Â± 8.6 vs 6.0 Â± 2.0 mg) and phenylephrine (105 Â± 25 mg) in the healthy women were required. There was no need for phenylephrine treatment in the preeclamptic group.

CONCLUSION: This study showed that the incidence and severity of spinal-induced hypotension in preeclamptic patients are less than in healthy women. The use of low dose spinal anaesthesia also contributed to this statement.