Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-28T16:58:19.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of volume preload on uteroplacental blood flow during epidural anaesthesia for Caesarean section

Published online by Cambridge University Press:  11 May 2005

W. Gogarten ,
D. Struemper ,
H. F. Gramke ,
H. Van Aken ,
H. Buerkle ,
M. Durieux  and
M. A. E. Marcus
W. Gogarten
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
D. Struemper
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
H. F. Gramke
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
H. Van Aken
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
H. Buerkle
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
M. Durieux
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
M. A. E. Marcus
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
Get access

Extract

Summary

Background and objective: Epidural and spinal anaesthesia are the preferred mode of anaesthesia for Caesarean section. Volume preloading is recommended to prevent maternal hypotension and a reduction in uteroplacental blood flow, although positive effects of volume preloading on maternal cardiac output and arterial pressure are debatable. Doppler measurements of the umbilical artery beyond deriving pulsatility indices are not routinely performed.

Methods: After Institutional Review Board approval and written informed consent, 14 consecutive women with epidural anaesthesia for Caesarean section received either hydroxyethyl starch 500 mL or gelatine 500 mL. Haemodynamic variables monitored were maternal arterial pressure, maximal blood flow velocity and pulsatility indices of the uterine artery derived from Doppler measurements.

Conclusions: Maternal arterial pressure and pulsatility indices in both groups did not change from baseline after intravenous colloid infusion. However, uterine blood flow increased significantly in both groups. The effectiveness of volume preloading may therefore be better described by changes in maximum uterine blood flow velocity than by pulsatility indices or maternal arterial pressure.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, epiduralBLOOD CIRCULATION, regional blood flowECHOCARDIOGRAPHY, DopplerPREGNANCY, feto–maternal exchange
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 5 , May 2005 , pp. 359 - 362
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Rout C, Rocke DA. Spinal hypotension associated with Cesarean section: will preload ever work? Anesthesiology 1999; 91: 1565–1567.Google Scholar
Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993; 79: 262–269.Google Scholar
Patton DE, Lee W, Miller J, Jones M. Maternal, uteroplacental, and fetoplacental hemodynamic and Doppler velocimetric changes during epidural anesthesia in normal labor. Obstet Gynecol 1991; 77: 17–19.Google Scholar
Vincent Jr RD, Werhan CF, Norman PF, et al. Prophylactic angiotensin II infusion during spinal anesthesia for elective cesarean delivery. Anesthesiology 1998; 88: 1475–1479.Google Scholar
Trudinger BJ, Cook CM, Giles WB, et al. Fetal umbilical artery velocity waveforms and subsequent neonatal outcome. Br J Obstet Gynaecol 1991; 98: 378–384.Google Scholar
Caritis SN, Abouleish E, Edelstone DI, Mueller-Heubach E. Fetal acid–base state following spinal or epidural anesthesia for cesarean section. Obstet Gynecol 1980; 56: 610–615.Google Scholar
Keeley MM, Wade RV, Laurent SL, Hamann VD. Alterations in maternal–fetal Doppler flow velocity waveforms in preterm labor patients undergoing magnesium sulphate tocolysis. Obstet Gynecol 1993; 81: 191–194.Google Scholar
Li P, Tong C, Eisenach JC. Pregnancy and ephedrine increase the release of nitric oxide in ovine uterine arteries. Anesth Analg 1996; 82: 288–293.Google Scholar
Alahuhta S, Räsänen J, Jouppila P, Jouppila R, Hollmén AI. Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Int J Obstet Anesth 1992; 1: 129–134.Google Scholar
Low JA. The current status of maternal and fetal blood flow velocimetry. Am J Obstet Gynecol 1991; 164: 1049–1063.Google Scholar
Morrow RJ, Bull SB, Adamson SL. Experimentally induced changes in heart rate alter umbilicoplacental hemodynamics in fetal sheep. Ultrasound Med Biol 1993; 19: 309–318.Google Scholar
Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for Cesarean delivery. Anesth Analg 2002; 94: 920–926.Google Scholar
Marcus MA, Vertommen JD, Van Aken H. Hydroxyethyl starch versus lactated Ringer's solution in the chronic maternal–fetal sheep preparation: a pharmacodynamic and pharmacokinetic study. Anesth Analg 1995; 80: 949–954.Google Scholar
Adamson SL, Morrow RJ, Bascom PA, Mo LY, Ritchie JW. Effect of placental resistance, arterial diameter, and blood pressure on the uterine arterial velocity waveform: a computer modeling approach. Ultrasound Med Biol 1989; 15: 437–442.Google Scholar
Kleiner-Assaf A, Jaffa AJ, Elad D. Hemodynamic model for analysis of Doppler ultrasound indexes of umbilical blood flow. Am J Physiol 1999; 276: H2204–H2214.Google Scholar
Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section. Anesthesiology 1999; 91: 1571–1576.Google Scholar
Boito S, Struijk PC, Ursem NTC, Stijnen T, Wladimiroff JW. Umbilical venous volume flow in the normally developing and growth-restricted human fetus. Ultrasound Obstet Gynecol 2002; 19: 344–349.Google Scholar
Morgan PJ, Halpern S, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg 2001; 92: 997–1005.Google Scholar
Heilmann L, von Tempelhoff GF. Doppler ultrasound results of hemodilution treatment. Zeitschrift für Geburtshilfe und Perinatologie 1993; 197: 43–47.Google Scholar
Vercauteren MP, Hoffmann V, Coppejans HC, Van Steenberge AL, Adriaensen HA. Hydroxyethylstarch compared with modified gelatine as volume preload before spinal anaesthesia for Caesarean section. Br J Anaesth 1996; 76: 731–733.Google Scholar