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A randomized trial comparing low-dose combined spinal-epidural anesthesia and conventional epidural anesthesia for cesarean section in severe preeclampsia.
Acta Anaesthesiol Belg 2005; 56(2):155-62AA

Abstract

BACKGROUND AND OBJECTIVES

A prospective, randomized study was designed to compare the maternal and neonatal effects of conventional epidural anesthesia and combined spinal epidural anesthesia (CSE) for Cesarean section in severe preeclamptic patients. Additionally, two strategies in the prophylactic management of hypotension in severe preeclamptic patients were evaluated: fluid preloading or prophylactic ephedrine.

METHODS

Thirty nonlaboring women with severe preeclampsia (PET), scheduled for an elective Cesarean section, were randomised into three groups: epidural anesthesia with prophylactic fluid loading (EA-F), combined spinal epidural anesthesia with prophylactic fluid loading (CSE-F), or combined spinal epidural anesthesia with prophylactic ephedrine (CSE-V). Hemodynamic data were recorded prior and after induction of regional anesthesia at five-minute intervals. The total amount of intravenous administered fluid and the total dose of vasopressors were recorded.

RESULTS

Hemodynamic data were similar between the three groups. The incidence and duration of hypotension was similar in all three groups. Significantly more ephedrine was used in the CSE-V group as compared to the CSE-F group. More lactated Ringer's solution was used in the CSE-F group as compared to the CSE-V group. There were no hypertensive episodes and none of the patients developed pulmonary edema. The time period from induction until the start of surgery and the duration of surgery were significantly shorter in both CSE-groups. Neonatal outcome was comparable between the three groups.

CONCLUSION

Our results confirm that combined spinal and epidural anesthesia (CSE) is a safe alternative to conventional epidural anesthesia in severe preeclamptic women and that the prophylactic use of ephedrine is effective and safe to prevent and treat spinal hypotension after combined spinal and epidural anesthesia for Cesarean section in severe preeclamptic women.

Authors+Show Affiliations

Department of Anesthesiology, University Hospitals Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, B-3000 Leuven, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16013660

Citation

Berends, N, et al. "A Randomized Trial Comparing Low-dose Combined Spinal-epidural Anesthesia and Conventional Epidural Anesthesia for Cesarean Section in Severe Preeclampsia." Acta Anaesthesiologica Belgica, vol. 56, no. 2, 2005, pp. 155-62.
Berends N, Teunkens A, Vandermeersch E, et al. A randomized trial comparing low-dose combined spinal-epidural anesthesia and conventional epidural anesthesia for cesarean section in severe preeclampsia. Acta Anaesthesiol Belg. 2005;56(2):155-62.
Berends, N., Teunkens, A., Vandermeersch, E., & Van de Velde, M. (2005). A randomized trial comparing low-dose combined spinal-epidural anesthesia and conventional epidural anesthesia for cesarean section in severe preeclampsia. Acta Anaesthesiologica Belgica, 56(2), pp. 155-62.
Berends N, et al. A Randomized Trial Comparing Low-dose Combined Spinal-epidural Anesthesia and Conventional Epidural Anesthesia for Cesarean Section in Severe Preeclampsia. Acta Anaesthesiol Belg. 2005;56(2):155-62. PubMed PMID: 16013660.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial comparing low-dose combined spinal-epidural anesthesia and conventional epidural anesthesia for cesarean section in severe preeclampsia. AU - Berends,N, AU - Teunkens,A, AU - Vandermeersch,E, AU - Van de Velde,M, PY - 2005/7/15/pubmed PY - 2005/10/5/medline PY - 2005/7/15/entrez SP - 155 EP - 62 JF - Acta anaesthesiologica Belgica JO - Acta Anaesthesiol Belg VL - 56 IS - 2 N2 - BACKGROUND AND OBJECTIVES: A prospective, randomized study was designed to compare the maternal and neonatal effects of conventional epidural anesthesia and combined spinal epidural anesthesia (CSE) for Cesarean section in severe preeclamptic patients. Additionally, two strategies in the prophylactic management of hypotension in severe preeclamptic patients were evaluated: fluid preloading or prophylactic ephedrine. METHODS: Thirty nonlaboring women with severe preeclampsia (PET), scheduled for an elective Cesarean section, were randomised into three groups: epidural anesthesia with prophylactic fluid loading (EA-F), combined spinal epidural anesthesia with prophylactic fluid loading (CSE-F), or combined spinal epidural anesthesia with prophylactic ephedrine (CSE-V). Hemodynamic data were recorded prior and after induction of regional anesthesia at five-minute intervals. The total amount of intravenous administered fluid and the total dose of vasopressors were recorded. RESULTS: Hemodynamic data were similar between the three groups. The incidence and duration of hypotension was similar in all three groups. Significantly more ephedrine was used in the CSE-V group as compared to the CSE-F group. More lactated Ringer's solution was used in the CSE-F group as compared to the CSE-V group. There were no hypertensive episodes and none of the patients developed pulmonary edema. The time period from induction until the start of surgery and the duration of surgery were significantly shorter in both CSE-groups. Neonatal outcome was comparable between the three groups. CONCLUSION: Our results confirm that combined spinal and epidural anesthesia (CSE) is a safe alternative to conventional epidural anesthesia in severe preeclamptic women and that the prophylactic use of ephedrine is effective and safe to prevent and treat spinal hypotension after combined spinal and epidural anesthesia for Cesarean section in severe preeclamptic women. SN - 0001-5164 UR - https://www.unboundmedicine.com/medline/citation/16013660/A_randomized_trial_comparing_low_dose_combined_spinal_epidural_anesthesia_and_conventional_epidural_anesthesia_for_cesarean_section_in_severe_preeclampsia_ L2 - http://www.diseaseinfosearch.org/result/5920 DB - PRIME DP - Unbound Medicine ER -