Measurement of Hemodynamic Variables Under Spinal Anesthesia With Varied Positioning
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Women's Studies |
| Therapuetic Areas: | Other, Reproductive |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 3/2/2019 |
| Start Date: | August 1, 2017 |
| End Date: | November 26, 2018 |
Measurement of Hemodynamic Variables Under Spinal Anesthesia in a Patient Undergoing Cesarean Section With Varied Positioning - a Comparative Study
Multiple studies have compared spinal anesthetic performed supine versus lateral, with
varying results, in parturients having elective cesarean section. Needle positioning during
spinal placement has also been examined. No positioning techniques have demonstrated
definitive superiority for hemodynamic stability.
Investigators propose that following spinal placement in the sitting position if the patient
is placed in a lateral position for 90 seconds prior to turning them supine, hemodynamic
changes caused by sympathectomy related to the subarachnoid block can be avoided.
This is the first study to examining the influence of position changes after spinal
anesthetic placement in the sitting position, which includes hemodynamic variables not
previously studied including cardiac output, TPR (total peripheral resistance) and pulse
pressure variation (PPV).
varying results, in parturients having elective cesarean section. Needle positioning during
spinal placement has also been examined. No positioning techniques have demonstrated
definitive superiority for hemodynamic stability.
Investigators propose that following spinal placement in the sitting position if the patient
is placed in a lateral position for 90 seconds prior to turning them supine, hemodynamic
changes caused by sympathectomy related to the subarachnoid block can be avoided.
This is the first study to examining the influence of position changes after spinal
anesthetic placement in the sitting position, which includes hemodynamic variables not
previously studied including cardiac output, TPR (total peripheral resistance) and pulse
pressure variation (PPV).
Cesarean section is chosen when natural spontaneous vaginal delivery is either not possible
or when the health of the baby or mother is compromised. Cesarean section may be planned,
urgent, or performed emergently when the life of the baby or mother is threatened.
Cesarean section is performed using different anesthetic techniques including: spinal,
epidural, combined spinal and epidural, and general anesthesia. Spinal anesthesia is the most
common technique chosen due to its relative safety, rapid onset and avoidance of potential
complications from general anesthesia. It is the technique of choice for elective cesarean
section unless contraindicated. Spinal anesthesia causes sympathetic blockade followed by
sensory and motor blockade. Nerve fiber size explains the speed of onset and differential
block. The critical moments during spinal anesthesia come as soon as local anesthetic is
injected into the subarachnoid space.
or when the health of the baby or mother is compromised. Cesarean section may be planned,
urgent, or performed emergently when the life of the baby or mother is threatened.
Cesarean section is performed using different anesthetic techniques including: spinal,
epidural, combined spinal and epidural, and general anesthesia. Spinal anesthesia is the most
common technique chosen due to its relative safety, rapid onset and avoidance of potential
complications from general anesthesia. It is the technique of choice for elective cesarean
section unless contraindicated. Spinal anesthesia causes sympathetic blockade followed by
sensory and motor blockade. Nerve fiber size explains the speed of onset and differential
block. The critical moments during spinal anesthesia come as soon as local anesthetic is
injected into the subarachnoid space.
Inclusion Criteria:
- Parturients undergoing elective cesarean section under spinal anesthesia
- Singleton intrauterine pregnancy with appropriate gestational age fetus (AGA) at
gestational age 37 to 42 weeks
Exclusion Criteria:
- Large for gestational age, small for gestational age, and multiple gestations
- Patients with cardiovascular disease like hypertension, etc.
- Non-English or non-Spanish speakers
- BMI >40
- Inadequate or failed blocks and inadvertently high levels of spinal blockade will be
dropped from the study
- Incarcerated parturients
- Expected heavy bleeding (placenta accreta, vascular anomaly, etc.)
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