Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2020; 8(8): 1444-1453
Published online Apr 26, 2020. doi: 10.12998/wjcc.v8.i8.1444
Hemodynamic characteristics in preeclampsia women during cesarean delivery after spinal anesthesia with ropivacaine
Na Zhao, Jin Xu, Xiao-Guang Li, Joseph Harold Walline, Yi-Chong Li, Lin Wang, Guo-Sheng Zhao, Ming-Jun Xu
Na Zhao, Xiao-Guang Li, Lin Wang, Guo-Sheng Zhao, Ming-Jun Xu, Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
Jin Xu, Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
Joseph Harold Walline, Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 9990777, China
Yi-Chong Li, Department of Clinical Research and Epidemiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China
Author contributions: Zhao N, Xu J, Li XG, and Xu MJ participated in the intellectual planning of the project; Zhao N, Li XG, Wang L, and Zhao GS completed the subject recruitment; Zhao N, Li XG, Wang L, and Zhao GS performed the data collection and analysis; Zhao N, Xu J, and Walline JH drafted the initial manuscript; Walline JH performed the language editing.
Supported by the Beijing Municipal Administration of Hospitals Youth Program Grant, No. QML20161403.
Institutional review board statement: Ethical approval was granted by the Beijing Obstetrics and Gynecology Hospital Ethics Review Committee.
Informed consent statement: All subjects provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ming-Jun Xu, MD, PhD, Chief Doctor, Professor, Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251, Yaojiayuan Road, Chaoyang District, Beijing 100026, China. xumingjun222@126.com
Received: December 13, 2019
Peer-review started: December 13, 2019
First decision: February 20, 2020
Revised: March 5, 2020
Accepted: April 1, 2020
Article in press: April 1, 2020
Published online: April 26, 2020
Processing time: 133 Days and 8.4 Hours
Abstract
BACKGROUND

Very few studies have been published on the hemodynamic changes associated with spinal anesthesia induced with ropivacaine during cesarean deliveries in preeclamptic women.

AIM

To record and analyze hemodynamic data in women with preeclampsia undergoing cesarean delivery after spinal anesthesia induced with ropivacaine.

METHODS

Ten eligible women with preeclampsia were enrolled in this prospective observational study. Spinal anesthesia was performed with 2.4 mL of 0.5% ropivacaine. Hemodynamic changes were then analyzed at multiple time points. The hemodynamic responses to vasopressor interventions and uterotonic agents, as well as maternal and neonatal outcomes were also recorded.

RESULTS

Stable hemodynamic trends were observed in this study. Cardiac output (CO) and stroke volume increased mildly during surgery. In contrast, mean arterial pressure and systemic vascular resistance showed a moderate decrease from induction until the end of surgery. Central venous pressure dramatically increased after delivery. Oxytocin administration was associated with the most significant hemodynamic fluctuations during surgery, namely, an increase in CO and heart rate. Phenylephrine intervention was only required in three patients, and caused an increase in mean arterial pressure and systemic vascular resistance along with a decrease in heart rate, stroke volume, and CO. No maternal and neonatal complications were observed during this study, except transient episodes of hypotension.

CONCLUSION

Spinal anesthesia for caesarian delivery with ropivacaine in women with preeclampsia is linked to modest hemodynamic changes of no clinical significance in this study. Careful cardiovascular monitoring is still recommended, particularly after the delivery of the fetus or the use of oxytocin.

Keywords: Preeclampsia; Cesarean delivery; Spinal anesthesia; Cardiac output; Hemodynamics

Core tip: This study is the first to investigate in detail the hemodynamic changes induced by spinal anesthesia with ropivacaine during cesarean delivery in women with preeclampsia. Intrathecal low-dose ropivacaine produces satisfactory anesthesia in cesarean deliveries and stable hemodynamics in preeclampsia patients. Based on the hemodynamic trends seen in this study, large amounts of pre-operative fluids or prophylactic vasopressors before anesthesia aimed at preventing intra-operative hypotension may not be necessary in patients with preeclampsia undergoing spinal anesthesia with low-dose ropivacaine.