Журнал «Медицина неотложных состояний» 3 (66) 2015

Abstract: Nowadays spinal anesthesia has become an excellent method of anesthesia for cesarean section. It has a many advantages. But arterial hypotension during spinal anesthesia stays common bad side of this method. Arterial hypotension has a bad influence to the mother and fetus.

Now necessity of the volume preload before spinal puncture is much discussed. Many scientists doubt in necessity big volume preload before spinal puncture.

The main aim of this study was: to conduct a retrospective analysis of the volumes preload and estimate effectiveness different volumes preload in the prevention of hypotension during spinal anesthesia for cesarean section.

Materials and Methods: We have done a retrospective analysis of 136 spinal anesthesia protocols for cesarean section, which were conducted in Kyiv Regional Obstetric Clinic. We didn`t incorporate to the study pregnant women, who have: hart diseases, arterial hypertension, preeclampsia (any degree), arterial hypotension before operation and term of pregnancy lower 36 weeks.

The volume preload was based only on infusion normal saline. All protocols were separated for two groups. The criterion for the distribution spinal anesthesia protocols into groups was amount of normal saline, which was included to the volume preload.

The first group included 99 protocols of spinal anesthesia, where volume preload based on infusion 400 ml normal saline (5 ml/kg). The second group included 37 protocols of spinal anesthesia, where volume preload based on infusion 800 ml normal saline (10 ml/kg). The volume preload was conducted during 10 – 20 minutes before spinal puncture. The groups were comparable in dose of anesthetic and level of sensitive block. Low arterial blood pressure which happened after spinal puncture was treated by phenylephrinum.

In these groups, we have analyzed a difference in frequency of appearance arterial hypotension, severity of arterial hypotension and difference in doses of phenylephrinum, which was used for treatment this complication.

Results: Retrospective analysis of the spinal anesthesia protocols for cesarean section have shown, that in the second group (where volume preload based on infusion 800 ml normal saline (10 ml/kg)) frequency of appearance arterial hypotension and it`s severity were higher than in the first group (where volume preload based on infusion 400 ml normal saline (5 ml/kg)). Similar results we have seen in doses of phenylephrinum, which was used for treatment this complication. This difference had statistic significance.

Summary: According to the results of the study, we can do next conclusion:

1. The volume preload isn`t always successful prevention measure for occurrence arterial hypotension during spinal anesthesia for cesarean section.

2. The more effective in prevention appearance of arterial hypotension during spinal anesthesia for cesarean section is volume preload based on infusion 400 ml normal saline (5 ml/kg).

3. If the volume preload increases, it will cause to elevation cases of arterial hypotension during spinal anesthesia for cesarean section.