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      Sequential compression pump effect on hypotension due to spinal anesthesia for cesarean section: A double blind clinical trial

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          Abstract

          Background

          Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80–85% after SA in pregnant women.

          Objective

          To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section.

          Methods

          This double-blind clinical prospective study was conducted on 76 non-laboring parturient patients, aged 18–45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016. Patients were divided into treatment mechanical pump (Group M) or control group (Group C) with simple random sampling. Fetal presentation, birth weight, Apgar at 1 and 5 min, time taken for pre-hydration (min), pre-hydration to the administration of spinal anesthesia (min), initiation of spinal to the delivery (min) and total volume of intravenous fluids, total dose of ephedrine and metoclopramide were recorded. Data were analyzed by SPSS version 19, using repeated measures of ANOVA and Chi square test.

          Results

          Heart rate, MPA, DAP and SAP changes were significantly higher in off-pump group in the baseline and 1st-minute (p<0.05), and in the other times, this change was significantly different with control groups.

          Conclusion

          This research showed the suitability of the use of Sequential Compression Device (SCD) in reducing hypotension after spinal anesthesia for cesarean section, also this method can cause reducing vasopressor dosage for increased blood pressure, but the approval of its effectiveness requires repetition of the study with a larger sample size.

          Trial registration

          The trial was registered at the Iranian Registry of Clinical Trials ( http://www.irct.ir) with the IRCT ID: IRCT2015011217742N3.

          Funding

          The authors received no financial support for the research, authorship, and/or publication of this article.

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          Most cited references9

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          Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.

          (2007)
          Article 0 comments Cited 62 times – based on 0 reviews     Review now
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            Maternal hypotension during spinal anesthesia for caesarean delivery.

            F Mercier, J M Augé, Ana C. Hoffmann … (2013)
            The aim of the study was to review maternal hypotension during caesarean delivery with spinal anesthesia. Obstetric complications, such as obstetric hemorrhage and problems related to concomitant maternal diseases are not considered. Reports of hypotension during spinal anesthesia for elective caesarean delivery are frequent (70-80%) when pharmacological prophylaxis is not used. Although some physical methods (leg wrapping, thromboembolic stockings) and the prevention of aorto-caval compression (left lateral tilt of the uterus) are useful, main prevention relies on two pharmacological methods, vasopressor therapy and intravascular fluid loading generally in combination. Ephedrine has been the vasopressor of choice in obstetrics for decades but phenylephrine is now the preferred first line approach during elective procedures at least. Crystalloid preloading is clinically ineffective and should be abandoned. Crystalloid coloading at the onset of sympathetic blockade is better but its efficacy may depend on the volume infused and the speed of administration. Preloading with hydroxyethylstarch is more consistently effective in reducing the incidence and severity of hypotension and hydroxyethylstarch coloading appears equally effective. Preoperative tests and new monitoring devices are available to predict or permit early detection of hypotension, but their feasibility and reliability in routine clinical practice is not yet established. With these tools, it may become possible to tailor prophylaxis to the assessed risk of the individual. Combining a prophylactic vasopressor regimen with hydroxyethylstarch preloading, hydroxyethylstarch coloading or crystalloid coloading is the best method to decrease the incidence and severity of hypotension during spinal anesthesia for caesarean delivery.
            Article 0 comments Cited 42 times – based on 0 reviews     Review now
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              Anaesthesia for Caesarean section and neonatal acid-base status: a meta-analysis.

              Charles Reynolds III, M P Seed (2005)
              Spinal anaesthesia is generally preferred for Caesarean section. Its superiority for the baby is often assumed. Umbilical artery acid-base status provides a valid index of fetal welfare. Twenty-seven studies reporting neonatal acid-base data with different types of anaesthesia were used to compare umbilical artery or vein pH and base deficit, using random-effect meta-analysis. Cord pH was significantly lower with spinal than with both general (difference: -0.015; 95% CI -0.029 to -0.001; 13 studies, 1272 subjects) and epidural anaesthesia (difference -0.013; 95% CI -0.024 to -0.002; 11 studies, 828 subjects). Larger doses of ephedrine contributed to the latter effect (p = 0.023). Sixteen studies reported a base deficit, which was significantly higher for spinal than for general (difference 1.109; 95% CI 0.434-1.784 mEq.l(-1); seven studies, 695 subject) and epidural anaesthesia (difference 0.910; 95% CI 0.222-1.598 mEq.l(-1); seven studies, 497 subjects). Spinal anaesthesia cannot be considered safer than epidural or general anaesthesia for the fetus.
              Article 0 comments Cited 41 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Electron Physician
                Journal ID (iso-abbrev): Electron Physician
                Journal ID (publisher-id): Electronic physician
                Title: Electronic Physician
                Publisher: Electronic physician
                ISSN (Electronic): 2008-5842
                Publication date Collection: May 2017
                Publication date (Electronic): 25 May 2017
                Volume: 9
                Issue: 5
                Pages: 4419-4424
                Affiliations
                [1 ]M.D., Anesthesiologist, Associate Professor, Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
                [2 ]M.D., Gynecologist, Assistant Professor, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
                Author notes
                Corresponding author: Associate Professor Dr. Fatemeh Javaherforoosh Zadeh, Department of Anesthesia, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Tel: +989161114831, Fax: +986132923980, Email: f_javaherforoosh@ 123456yahoo.com
                Article
                Publisher ID: epj-09-4419
                DOI: 10.19082/4419
                PMC ID: 5498709
                SO-VID: 216360b5-18d5-43e3-b8b8-3b04b9daf271
                Copyright © © 2017 The Authors
                License:

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

                History
                Date received : 02 May 2016
                Date accepted : 22 September 2016
                Categories
                Subject: Original Article

                Keywords: sequential compression pump,hypotension,cesarean section,spinal anesthesia
                Data availability:
                Keywords: sequential compression pump, hypotension, cesarean section, spinal anesthesia

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