Perioperative hemodynamic response and vasopressor requirement during spinal anesthesia for cesarean section in healthy and severe preeclamptic parturients: a prospective cohort comparison

ABSTRACT

This study was done to compare the heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBF] mean arterial pressure [MAP] ephedrine requirement and neonatal outcome between normotensive and severe pre-eclamptic women undergoing caesarean section under spinal anaesthesia. We enrolled a total of 30 healthy [control group] and 30 severe pre-eclamptic [BP > 160/110 mmHg] parturients [study group] above 18 years of age, undergoing elective cesarean section in the study. After preloading with 10 ml/kg of ringer lactate solution spinal anesthesia was administered with 12.5 mg of hyperbaric bupivacaine. SBP, DBP, MAP and HR were recorded before spinal anesthesia and at every 2 min intervals after spinal anesthesia for the first 20 min, and then after every 5 min till completion of surgery. Ephedrine was administered in 5 mg bolus dose when MAP decreased more than 20% of base line. Apgar score was noted at 1 and 5 min after birth. Hemodynamic variables were also noted four hourly in post-operative period for 24 hours in both of the groups. The blood pressure records were statistically lower at all intervals throughout the study in normotensive group as compared to pre-eclamptic group. The number of episodes of hypotension was more in normotensive group as compared to pre-eclamptic group and the result was statistically significant [p < 0.05]. The mean ephedrine requirement in the normotensive group [13.4 i 7.66 mg] was significantly more [P-value 0.0005] than in pre-eclamptic group [6.6 i 6.75 mg]. Apgar scores at 1 and 5 min after birth were comparable in both of the groups. Pre-eclamptic patients had less hypotension after spinal anesthesia, required less ephedrine than normotensives but had comparable fetal Apgar scores