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Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study.
Anesth Analg 2005; 101(3):862-8, table of contentsA&A

Abstract

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.

Authors+Show Affiliations

Department of Anesthesiology, Siriraj Hospital, Bangkoknoi, Bangkok 10700, Thailand. sisps@mahidol.ac.thNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16116005

Citation

Visalyaputra, Shusee, et al. "Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: a Prospective Randomized, Multicenter Study." Anesthesia and Analgesia, vol. 101, no. 3, 2005, 862-8, table of contents.
Visalyaputra S, Rodanant O, Somboonviboon W, et al. Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. Anesth Analg. 2005;101(3):862-8, table of contents.
Visalyaputra, S., Rodanant, O., Somboonviboon, W., Tantivitayatan, K., Thienthong, S., & Saengchote, W. (2005). Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. Anesthesia and Analgesia, 101(3), 862-8, table of contents.
Visalyaputra S, et al. Spinal Versus Epidural Anesthesia for Cesarean Delivery in Severe Preeclampsia: a Prospective Randomized, Multicenter Study. Anesth Analg. 2005;101(3):862-8, table of contents. PubMed PMID: 16116005.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal versus epidural anesthesia for cesarean delivery in severe preeclampsia: a prospective randomized, multicenter study. AU - Visalyaputra,Shusee, AU - Rodanant,Oraluxna, AU - Somboonviboon,Wanna, AU - Tantivitayatan,Kamthorn, AU - Thienthong,Somboon, AU - Saengchote,Wanawimol, PY - 2005/8/24/pubmed PY - 2005/9/28/medline PY - 2005/8/24/entrez SP - 862-8, table of contents JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 101 IS - 3 N2 - 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. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/16116005/Spinal_versus_epidural_anesthesia_for_cesarean_delivery_in_severe_preeclampsia:_a_prospective_randomized_multicenter_study_ L2 - http://dx.doi.org/10.1213/01.ANE.0000160535.95678.34 DB - PRIME DP - Unbound Medicine ER -