168 Obstetric Anaesthesia

line haemodynamic measurements. The following maternal haemodynamic 11AP3-8

parameters were measured by noninvasive bioimpedans technology: heart
rate (HR), mean blood pressure (BP), cardiac index (CI), systemic vascular Ringer’s lactate (RL) and balanced Ringer’s solution (BR)
resistance (SVR). Data were recorded before induction (baseline), af ter in- during elective Caesarean delivery in spinal anaesthesia:
duction of anaesthesia (prenatal), af ter delivery (postnatal) and at the end of ef fects on neonatal homeostasis
operation. Mann - Whitney U test was used for statistical analysis.
Kiss K., Zimányi M., Agócs S., Bodonovits A., Orvos H., Molnár Z.
Results and Discussion: Results are presented in the table below as
Universit y of Szeged, Depar tment of Anaesthesiology and Intensive Care,
mean±SD, *p< 0.05 considered as statistically significant. HR was signifi-
Szeged, Hungar y
cantly higher in GA group at all stages of the operation. BP was significantly
higher in GA group on prenatal and postnatal stages than in SA group. CI Background: Balanced solutions may be superior to unbalanced infusions
was significantly higher in SA group at the prenatal stage, whereas SVR was during fluid resuscitation. There is some evidence that during Caesarean sec-
significantly higher at the prenatal stage in GA group. tion ephedrine can pass the placenta and cause metabolic acidosis in the
newborn (1). Whether intravenous infusions af fect the newborn during and
  Group Baseline Prenatal Postnatal End of operation af ter Caesarean section is unknown. Our aim was to compare the ef fects of
intraoperative RL vs BR on the homeostasis of the newborn.
HR SA 90.2±2.4 84.6±4.1* 84.7±3.2* 79.9±2.6* Methods: We performed a prospective randomised controlled clinical trial
HR GA 84.9±2.4 114.6±2.4 98.7±3.6 99.4±2.9 on 102 patients. Af ter Ethics Comit tee approval, and informed consent all
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BP SA 112.9±3.4 108.1±2.9* 104.6±2.5* 103.6±2.8 pregnant women scheduled for elective Caesarean section were recruited.
In cases of: fetal distress, severe comorbidities, urgent Caesarean section by
BP GA 106.6±2.3 130.2±2.9 95.4±2.7 98.4±2.8
any causes, patients were excluded. Patients were randomised into RL (n=49)
CI SA 3.4±0,1 3.5±0.1* 3.7±0.2 3.3±0.1 and the Balanced Ringer’s (BR) groups (n=53). Maternal cardio-respiratory
CI GA 3.3±0,1 3.1±0.1 3.5±0.1 3.4±0.1 parameters (MAP, HR, SpO2) were recorded in 5 timepoints: 1-before spi-
SVR SA 1457.8±82.5 1340.9±62.3* 1240.6±62.3 1341.5±71.4 nal anaesthesia, 2-af ter prone positioning, 3-incision, 4-ex traction, 5-cut ting
trough the umbilical cord. The type and volume of the given infusion, the re-
SVR GA 1432.7±93.2 1813.3±86.5 1120.2±65.4 1198.9±66.1
quired ephedrine dose were also recorded. Umbilical vein (t0), and af ter 1
[Table 1] hour (t1) capillary blood gas samples were taken from the neonates. Primary
end point of the study was the acid-base balance at t0 and t1.
Conclusion(s): This study demonstrated bet ter haemodynamic stability if SA Results: Patients in both groups received similar amount of crystalloid
is used during caesarean section in pregnant women with chronic arterial (RL=572±442; BR=617±260 ml), colloid (RL=293±198; BR=364±241 ml)
hypertension compared to GA with sevoflurane. and ephedrine (RL=8.0±4.9; BR=8.0±4.5 mg), and remained haemodynami-
cally stable with no significant dif ference between the groups. There was a
significant increase in the serum lactate levels in both groups af ter 1 hour:
11AP3-7 RL: t0=1.9 (1.3-2.3), t1=2.9 (1.9-3.3) ; BR: t0 =1.5 (1.2-1.8), t1 =2.4 (2.0-2.9)
mmol/L (p< 0.001), but there was no dif ference between the groups, and the
Airway variables associated with adverse pregnancy outcomes
pH, PaCO2 was also within the normal range in both groups. There were more
and symptoms of sleep-disordered breathing newborns with lactate ≥ 3mmol/L at t1 in the RL (n=20) vs. BR (n=10) but it did
Bullough A.S., O’Brien L.M. not reach statistical significance.
Universit y of Michigan, Depar tments of Anesthesiology, Neurology, Sleep Conclusion: These results suggest that both infusions can be safely used
Disorders Center and Oral and Ma xillofacial Surger y, Ann Arbor, United during routine Caesarean sections.The finding that there was a significant in-
States crease in the newborns’ postoperative lactate levels 1 hour af ter delivery in
Background: Data shows sleep-disordered breathing (SDB) increases in the whole sample, has not been reported yet, and although it did not cause
pregnancy and is related to adverse pregnancy outcomes. Simple assess- acid-base imbalance, it requires further studies for explanation.
ments can identif y those at high risk of SDB, yet their usefulness in identif ying References:
1. Ngan Kee WD et al. Anesthesiology 2009; 111: 506-512.
risk for adverse outcomes in pregnancy is unknown. We examined the as-
sociations between hypertensive disorders of pregnancy and non-invasive
markers of SDB.
Methods: A retrospective review was performed of all admissions to the ob- 11AP3-10
stetric suite at an academic, tertiary referral center from September 2005 to No benefice of low-dose bupivacaine (7.5mg) in spinal
December 2010. Demographic variables, diagnosis codes for gestational hy- anaesthesia for Caesarean delivery to prevent hypotension
pertension and pre-eclampsia, BMI, MMP (Modified Mallampat ti) scores, and
Neck Circumference (NC) were ex tracted from medical records. Women were Bouslama M.A., Ghaddab A., Khouadja H., Beji T., Tarmiz K., Ben Jazia K.
at risk of SDB if they had a MMP III/ IV and/or NC≥40cm. Logistic regression Farhat Hached Hospital, Depar tment of Anaesthesiology and Intensive Care,
models determined which airway variables were independent predictors for Sousse, Tunisia
the outcomes (gestational hypertension and pre-eclampsia). The C-statistic Background and Goal of Study: Spinal anaesthesia is the preferred anaes-
was used to measure the area under the curve of a receiver operator char- thetic technique for elective Caesarean deliveries. Hypotension is the most
acteristic curve. This allows determination of the probability that a classifier common side-ef fect and has both maternal and neonatal consequences. Dif-
will rank a randomly chosen disease-positive subject higher than a disease ferent strategies have been at tempted to prevent spinal-induced hypotension,
negative subject. including the use of low-dose bupivacaine.
Results: 17,083 medical records were identified. Complete airway data was Materials and Methods: Following Research Ethics Board approval and
available in 10,973 subjects (64%). of the sample. Women with MMP III/IV were informed consent eighty six ASA1 women scheduled for elective caesarean
more likely to report snoring than women with MMP I/II (25.8% vs. 16.9%; section were randomized into two groups A and B receiving respectively 10
p< 0.001); similarly those with NC ≥40 cm were more likely to report snor- and 7.5 mg of hyperbaric bupivacaine both with 25 microg of fentanyl and 100
ing than those without (46.3% vs. 17.4%; p< 0.001). Women with MMP III/IV, microg of morphine in spinal anaesthesia. All patients’ intravenous fluid and
compared to those without, were more likely to have pre-eclampsia (10.3% vs. vasopressor administration were standardized. Sensory block level and the
5.2%, p< 0.001). Women with NC ≥40cm, compared to those without, were incidence of hypotension were evaluated from the time of injection to delivery.
more likely to have gestational hypertension (4.8% vs. 2.1%, p< 0.001) and Results and Discussion: Peak sensory level was higher and motor block
pre-clampsia (10.9% vs. 4.4%, p< 0.001). Using the C-statistic, for the total more intense in groupe A. Four patients in group B required and epidural
sample (n=10,973), the model for gestational hypertension, including the in- supplementation of 1% lidocaine. The incidence of hypotension was similar
dependently associated variables of obesity, and thick/obese neck was 0.62; in both groups. In group A larger dose of ephedrine was needed (21, 98 mg
for pre-eclampsia, the independent variables were thick/obese neck, MMP versus 19, 98; p= 0.042).
score III/IV, and obesity, C statistic of 0.61. In the subgroup of women with Conclusion(s): The development of hypotension af ter spinal block in sub-
neck circumference measures (n=2733), the above models were repeated jects undergoing cesarean section was not prevented despite low-dose (7.5
with minimal change. mg). It also compromises anaesthetic ef ficacy.
Conclusion: Non-invasive markers of SDB are associated with hypertensive
disorders of pregnancy. Simple non-invasive airway assessments may have
clinical utility in the obstetric set ting.