engleski

Combined spinal epidural with epidural volume extension versus spinal anesthesia for caesarean section : multivariate analysis of factors affecting umbilical arterial ph

Background and aims: The present study was designed to examine the influence of epidural volume effect on the spread and duration of low dose hyperbaric levobupivacaine. The aim of this study was to evaluate the influence of epidural restriction on the incidence of hypotension, ephedrine consumption, cord-pH during the Caesarean section. Methods: 60 full term parturient women (ASA I or II) with uncomplicated pregnancies were prospectively randomized into two groups: 37 women's into single shot spinal anaesthesia group(SSSA) and 39 women's into combined spinal-epidural anaesthesia group (CSE-EVR). The initial dose for CSE-EVR was exactly half of the SSSA dose (0, 5mg per 10cm height of hyperbaric levobupivacaine and 20microg fentanyl). After spinal injection, an epidural catheter was located in the CSE-EVR and injected a volume of 20ml saline solution. We evaluated the height of the block by the pinprick method and the motor block by Bromage scale.Hemodynamic monitoring (NIBP, HR) was assessed every 2 minutes until the childbirth, then every 5 minutes during operative time. Anaesthetic efficacy was evaluated for breakthrough pain by visual analogue pain score (VAPS), Apgar score at birth, umbilical artery-pH, and epinephrine consumption. Results: The incidence of hypotension and ephedrine supplementation was significantly lower in the CSE-EVR group (19 patients vs.35) than in the SSSA group (p< 0.05). Multiple linear regression analysis of cord- pH with ephedrine as depend factor: cord-pH=7, 329 -0, 003Ephedrine (R2=0, 089) In the regression analysis we incorporate all the other variables like the group belong, ephedrine consumption, and intraoperative mean pressure we achieve: cord-pH=7, 08+0, 001Ephedrine+0, 003RRmean-0, 072Group (R2=0, 391) Conclusions: We conclude that in order to minimise the risk of fetal acidosis the CSE-EVR techniques should be used. The ephedrine use, the intensity and duration of hypotension can be reduced with low dose CSE-EVR anaesthesia.

spinal ; epidural volume ; CS ; hypothension ; PH

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