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
ARTICLE HIGHLIGHTS
Research background

Preeclampsia is a common perinatal complication and is one of the major hazards of pregnancy. Cesarean section is a common way to end pregnancy in patients with preeclampsia. Spinal anesthesia can provide satisfactory anesthesia for cesarean section, but its maternal vital sign fluctuations, such as low blood pressure, often affect maternal and fetal blood supply, which can lead to bad outcomes. Therefore, better monitoring and early treatment are the focus of anesthesia management during cesarean section for preeclampsia patients.

Research motivation

Ropivacaine is one of the more common local anesthetics for spinal anesthesia in cesarean section. Based on current clinical practice and research, it can provide satisfactory anesthesia for cesarean section, but the specific effects of ropivacaine on the hemodynamics of patients with preeclampsia undergoing cesarean section are unknown. Understanding the effects of ropivacaine on such patients can help improve anesthesia management, reduce related complications, and increase maternal satisfaction.

Research objectives

The aim of this study was to record and analyze vital sign data in women with preeclampsia undergoing cesarean delivery after spinal anesthesia using ropivacaine.

Research methods

We adopted a moderately invasive monitoring system to observe the changes in cardiac output, heart rate, blood pressure, central venous pressure, and heart stroke volume of patients with preeclampsia during cesarean delivery under spinal anesthesia using ropivacaine at multiple time points. These changes were then analyzed.

Research results

In women with preeclampsia who received spinal anesthesia with ropivacaine, we found several trends. Overall changes in the above indicators were mild throughout the operation, with only three out of ten patients needing medication to raise blood pressure at any time during the procedure. At the same time, ropivacaine provided satisfactory anesthesia to ensure a comfortable and smooth operation. No maternal or neonatal complications were observed during this study, except temporary episodes of low blood pressure.

Research conclusions

This study confirms that ropivacaine can provide satisfactory anesthesia and stable blood pressure during cesarean section in patients with preeclampsia. This study is the first to describe vital sign trends in detail in preeclamptic women receiving spinal anesthesia with ropivacaine. We hope that these data can support future perioperative monitoring and interventions.