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Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial.
Anaesthesia 2018; 73(1):23-31A

Abstract

We examined the haemodynamic effects of colloid preload, and phenylephrine and ephedrine administered for spinal hypotension, during caesarean section in 42 women with severe early onset pre-eclampsia. Twenty patients with pre-delivery spinal hypotension were randomly allocated to receive an initial dose of either 50 μg phenylephrine or 7.5 mg ephedrine; the primary outcome was percentage change in cardiac index. After a 300-ml colloid preload, mean (SD) cardiac index increased from 4.9 (1.1) to 5.6 (1.2) l.min-1 .m-2 (p < 0.01), resulting from an increase in both heart rate, from 81.3 (17.2) to 86.3 (16.5) beats.min-1 (p = 0.2), and stroke volume, from 111.8 (19.0) to 119.8 (17.9) ml (p = 0.049). Fourteen (33%) and 23 (54.8%) patients exhibited a stroke volume response > 10% and > 5%, respectively; a significant negative correlation was found between heart rate and stroke volume changes. Spinal hypotension in 20 patients was associated with an increase from baseline in cardiac index of 0.6 l.min-1 .m-2 (mean difference 11.5%; p < 0.0001). After a median [range] dose of 50 [50-150] μg phenylephrine or 15 [7.5-37.5] mg ephedrine, the percentage change in cardiac index during the measurement period of 150 s was greater, and negative, in patients receiving phenylephrine vs. ephedrine, at -12.0 (7.3)% vs. 2.6 (6.0)%, respectively (p = 0.0001). The percentage change in heart rate after vasopressor was higher in patients receiving phenylephrine, at -9.1 (3.4)% vs. 5.3 (12.6)% (p = 0.0027), as was the change in systemic vascular resistance, at 22.3 (7.5) vs. -1.9 (10.5)% (p < 0.0001). Phenylephrine effectively reverses spinal anaesthesia-induced haemodynamic changes in severe pre-eclampsia, if left ventricular systolic function is preserved.

Authors+Show Affiliations

Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29086911

Citation

Dyer, R A., et al. "Maternal Cardiac Output Response to Colloid Preload and Vasopressor Therapy During Spinal Anaesthesia for Caesarean Section in Patients With Severe Pre-eclampsia: a Randomised, Controlled Trial." Anaesthesia, vol. 73, no. 1, 2018, pp. 23-31.
Dyer RA, Daniels A, Vorster A, et al. Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial. Anaesthesia. 2018;73(1):23-31.
Dyer, R. A., Daniels, A., Vorster, A., Emmanuel, A., Arcache, M. J., Schulein, S., ... van Dyk, D. (2018). Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial. Anaesthesia, 73(1), pp. 23-31. doi:10.1111/anae.14040.
Dyer RA, et al. Maternal Cardiac Output Response to Colloid Preload and Vasopressor Therapy During Spinal Anaesthesia for Caesarean Section in Patients With Severe Pre-eclampsia: a Randomised, Controlled Trial. Anaesthesia. 2018;73(1):23-31. PubMed PMID: 29086911.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre-eclampsia: a randomised, controlled trial. AU - Dyer,R A, AU - Daniels,A, AU - Vorster,A, AU - Emmanuel,A, AU - Arcache,M J, AU - Schulein,S, AU - Reed,A R, AU - Lombard,C J, AU - James,M F, AU - van Dyk,D, Y1 - 2017/10/31/ PY - 2017/08/03/accepted PY - 2017/11/1/pubmed PY - 2018/11/6/medline PY - 2017/11/1/entrez KW - blood pressure KW - cardiac output measurement KW - ephedrine KW - hypotension KW - phenylephrine KW - pre-eclampsia KW - preload KW - spinal anaesthesia KW - vasopressors SP - 23 EP - 31 JF - Anaesthesia JO - Anaesthesia VL - 73 IS - 1 N2 - We examined the haemodynamic effects of colloid preload, and phenylephrine and ephedrine administered for spinal hypotension, during caesarean section in 42 women with severe early onset pre-eclampsia. Twenty patients with pre-delivery spinal hypotension were randomly allocated to receive an initial dose of either 50 μg phenylephrine or 7.5 mg ephedrine; the primary outcome was percentage change in cardiac index. After a 300-ml colloid preload, mean (SD) cardiac index increased from 4.9 (1.1) to 5.6 (1.2) l.min-1 .m-2 (p < 0.01), resulting from an increase in both heart rate, from 81.3 (17.2) to 86.3 (16.5) beats.min-1 (p = 0.2), and stroke volume, from 111.8 (19.0) to 119.8 (17.9) ml (p = 0.049). Fourteen (33%) and 23 (54.8%) patients exhibited a stroke volume response > 10% and > 5%, respectively; a significant negative correlation was found between heart rate and stroke volume changes. Spinal hypotension in 20 patients was associated with an increase from baseline in cardiac index of 0.6 l.min-1 .m-2 (mean difference 11.5%; p < 0.0001). After a median [range] dose of 50 [50-150] μg phenylephrine or 15 [7.5-37.5] mg ephedrine, the percentage change in cardiac index during the measurement period of 150 s was greater, and negative, in patients receiving phenylephrine vs. ephedrine, at -12.0 (7.3)% vs. 2.6 (6.0)%, respectively (p = 0.0001). The percentage change in heart rate after vasopressor was higher in patients receiving phenylephrine, at -9.1 (3.4)% vs. 5.3 (12.6)% (p = 0.0027), as was the change in systemic vascular resistance, at 22.3 (7.5) vs. -1.9 (10.5)% (p < 0.0001). Phenylephrine effectively reverses spinal anaesthesia-induced haemodynamic changes in severe pre-eclampsia, if left ventricular systolic function is preserved. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/29086911/Maternal_cardiac_output_response_to_colloid_preload_and_vasopressor_therapy_during_spinal_anaesthesia_for_caesarean_section_in_patients_with_severe_pre_eclampsia:_a_randomised_controlled_trial_ L2 - https://doi.org/10.1111/anae.14040 DB - PRIME DP - Unbound Medicine ER -