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Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery.
Anesth Analg 2005; 101(3):869-75, table of contentsA&A

Abstract

We previously showed that, in comparison with term healthy parturients, patients with severe preeclampsia had a less frequent incidence of spinal hypotension, which was less severe and required less ephedrine. In the present study, we hypothesized that these findings were attributable to preeclampsia-associated factors rather than to a smaller uterine mass. The incidence and severity of hypotension were compared between severe preeclamptics (n = 65) and parturients with preterm pregnancies (n = 71), undergoing spinal anesthesia for cesarean delivery (0.5% bupivacaine, sufentanil, morphine). Hypotension was defined as the need for ephedrine (systolic blood pressure <100 mm Hg in parturients with preterm fetuses or 30% decrease in mean blood pressure in both groups). Apgar scores and umbilical arterial blood pH were also studied. Neonatal and placental weights were similar between the groups. Hypotension was less frequent in preeclamptic patients than in women with preterm pregnancies (24.6% versus 40.8%, respectively, P = 0.044). Although the magnitude of the decrease in systolic, diastolic, and mean arterial blood pressure was similar between groups, preeclamptic patients required less ephedrine than women in the preterm group to restore blood pressure to baseline levels (9.8 +/- 4.6 mg versus 15.8 +/- 6.2 mg, respectively, P = 0.031). The risk of hypotension in the preeclamptic group was almost 2 times less than that in the preterm group (relative risk = 0.603; 95% confidence interval, 0.362-1.003; P = 0.044). The impact of Apgar scores was minor, and umbilical arterial blood pH was not affected. We conclude that preeclampsia-associated factors, rather than a smaller uterine mass, account for the infrequent incidence of spinal hypotension in preeclamptic patients.

Authors+Show Affiliations

Fédération Anesthésie-Douleur-Urgences-Réanimation, GHU Caremeau, Place du Pr Robert Debré, 30029 Nîmes cedex 9, France. guy.aya@chu-nimes.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

16116006

Citation

Aya, Antoine G M., et al. "Spinal Anesthesia-induced Hypotension: a Risk Comparison Between Patients With Severe Preeclampsia and Healthy Women Undergoing Preterm Cesarean Delivery." Anesthesia and Analgesia, vol. 101, no. 3, 2005, 869-75, table of contents.
Aya AG, Vialles N, Tanoubi I, et al. Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. Anesth Analg. 2005;101(3):869-75, table of contents.
Aya, A. G., Vialles, N., Tanoubi, I., Mangin, R., Ferrer, J. M., Robert, C., ... de La Coussaye, J. E. (2005). Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. Anesthesia and Analgesia, 101(3), 869-75, table of contents.
Aya AG, et al. Spinal Anesthesia-induced Hypotension: a Risk Comparison Between Patients With Severe Preeclampsia and Healthy Women Undergoing Preterm Cesarean Delivery. Anesth Analg. 2005;101(3):869-75, table of contents. PubMed PMID: 16116006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spinal anesthesia-induced hypotension: a risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. AU - Aya,Antoine G M, AU - Vialles,Nathalie, AU - Tanoubi,Issam, AU - Mangin,Roseline, AU - Ferrer,Jean-Michel, AU - Robert,Colette, AU - Ripart,Jacques, AU - de La Coussaye,Jean-Emmanuel, PY - 2005/8/24/pubmed PY - 2005/9/28/medline PY - 2005/8/24/entrez SP - 869-75, table of contents JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 101 IS - 3 N2 - We previously showed that, in comparison with term healthy parturients, patients with severe preeclampsia had a less frequent incidence of spinal hypotension, which was less severe and required less ephedrine. In the present study, we hypothesized that these findings were attributable to preeclampsia-associated factors rather than to a smaller uterine mass. The incidence and severity of hypotension were compared between severe preeclamptics (n = 65) and parturients with preterm pregnancies (n = 71), undergoing spinal anesthesia for cesarean delivery (0.5% bupivacaine, sufentanil, morphine). Hypotension was defined as the need for ephedrine (systolic blood pressure <100 mm Hg in parturients with preterm fetuses or 30% decrease in mean blood pressure in both groups). Apgar scores and umbilical arterial blood pH were also studied. Neonatal and placental weights were similar between the groups. Hypotension was less frequent in preeclamptic patients than in women with preterm pregnancies (24.6% versus 40.8%, respectively, P = 0.044). Although the magnitude of the decrease in systolic, diastolic, and mean arterial blood pressure was similar between groups, preeclamptic patients required less ephedrine than women in the preterm group to restore blood pressure to baseline levels (9.8 +/- 4.6 mg versus 15.8 +/- 6.2 mg, respectively, P = 0.031). The risk of hypotension in the preeclamptic group was almost 2 times less than that in the preterm group (relative risk = 0.603; 95% confidence interval, 0.362-1.003; P = 0.044). The impact of Apgar scores was minor, and umbilical arterial blood pH was not affected. We conclude that preeclampsia-associated factors, rather than a smaller uterine mass, account for the infrequent incidence of spinal hypotension in preeclamptic patients. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/16116006/Spinal_anesthesia_induced_hypotension:_a_risk_comparison_between_patients_with_severe_preeclampsia_and_healthy_women_undergoing_preterm_cesarean_delivery_ L2 - http://dx.doi.org/10.1213/01.ANE.0000175229.98493.2B DB - PRIME DP - Unbound Medicine ER -