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Prevention of maternal hypotension during elective caesarean section under spinal anaesthesia with an intermittent pneumatic compression system in lower extremities: preliminary study


Puyo, M.1; Garcia-Orellana, M.2; González-Núñez, M.1; Manrique, S.3; Suescun, M. C.3; Trillo, L.2

European Journal of Anaesthesiology (EJA): June 2014 - Volume 31 - Issue - p 191
Obstetric Anaesthesia

1University Hospital Germans Trias i Pujol, Dept of Anaesthesiology & Intensive Care, Badalona, Spain, 2Parc de Salut Mar, Dept of Anaesthesiology & Intensive Care, Barcelona, Spain, 3University Hospital Vall d'Hebron, Dept of Anaesthesiology & Intensive Care, Barcelona, Spain

Background and Goal of Study: Hypotension after regional anaesthesia for caesarean section (CS) remains a common clinical problem. The aim of this study was to evaluate the effectiveness of intermittent pneumatic compression system (IPCS) in lower extremities for preventing maternal hypotension after spinal anaesthesia (SA).

Materials and methods: During 3 months patients scheduled for elective CS were randomised to have an IPCS on their legs before SA (G2) or not (G1: control). Exclusion criteria: age < 18 ys, non-elective CS, BMI > 40, gravidity hypertension, high-risk patients, sepsis, insulin-dependent diabetes mellitus, spinal block level > T5, ongoing epidural anaesthesia and multiple gravidities. Crystalloid cohydration with 500 ml saline solution IV was given. SA was performed with a 25G needle in the interspace L2/L3 in left side decubitus with hyperbaric bupivacaine 0.5% adjusted to height. Hypotension was defined as 30% decrease from initial systolic arterial pressure (SAP) or SAP lower than 90 mmHg. A prophylactic variable rate regimen of phenylephrine (P) infusion was titrated and rescue boluses were administered for maintenance of SAP using algorithms. Predelivery we recorded: demographics, oxygen saturation (SpO2), heart rate and basal blood pressure values and post-SA (systolic, mean and diastolic arterial pressure) every 2 min, umbilical cord blood gas values (UCBGV), APGAR scores after 1 min/5 min, P total doses, P boluses needed and final haemoglobin values. Data are presented as percentages, mean values ± standard deviation.

Results: A total of 26 patients were included (G1: 16, G2:10). Demographics, heart rates, UCBGV, APGAR scores, neonatal outcomes and haemoglobin values were not different among groups. Total phenylephrine consumption was 0.451±1.77 μg/kg/min in G1 and 0.370±0.10 μg/kg/min in G2 (p=0.241). 43.8% of the patients in G1 needed P rescue boluses versus 40% in G2 (p=0.588). The mean arterial pressure after SA was 85.8±13.89 mmHg in G1 versus 90.6±13.64 mmHg in G2 (p=0.404). IPCS was well tolerated.

Conclusion(s): An intermittent pneumatic compression system on legs is an easy, noninvasive and nonpharmacological effective prophylactic method for preventing maternal hypotension after spinal anaesthesia for elective caesarean section. Our preliminary results point out a trend towards a reduction of vasoconstrictor requirements without side-effects. A bigger sample size will probably show a statistical significance among groups.

© 2014 European Society of Anaesthesiology