Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Eur J Anaesthesiol. 2013 Jan;30(1):9-15. doi: 10.1097/EJA.0b013e3283564698.
Hypotension following spinal anaesthesia for caesarean delivery may decrease uteroplacental perfusion and produce foetal acidosis. The optimal anaesthetic technique for mothers with foetal growth restriction and impaired Doppler flow is unclear.
To compare the effects of low-dose spinal anaesthesia and general anaesthesia on neonatal outcome and maternal haemodynamics.
Prospective, randomised clinical trial.
Tertiary care hospital.
Forty pregnant women with foetal growth restriction and impaired Doppler flow scheduled for elective caesarean delivery.
The women were allocated randomly to receive a low-dose spinal anaesthetic (8-mg hyperbaric bupivacaine 0.5% with fentanyl 20 μg) or standard general anaesthesia for elective caesarean delivery. SBP was maintained between 80 and 100% of baseline using bolus doses of phenylephrine. The total duration of hypotension, dose of phenylephrine used and any incidence of hypotension, nausea or vomiting were recorded.
The primary outcome variable was arterial and venous umbilical cord base deficit. Neonatal outcome and maternal haemodynamics were analysed as secondary endpoints.
The mean umbilical artery pH was significantly lower in the low-dose spinal anaesthesia group than in the general anaesthesia group (7.23 ± 0.06 vs. 7.27 ± 0.04, P = 0.01). Cord base deficit was similar in the two groups. Higher partial pressures of oxygen occurred in the general anaesthesia group (20.9 ± 6.5 kPa) than in the low-dose spinal anaesthesia group (13.6 ± 6.1 kPa, P = 0.001). No difference was observed between groups in 1 and 5-min Apgar scores. There appeared to be a greater need for immediate resuscitation of neonates in the general anaesthesia group, but the difference was not statistically significant (P = 0.51). Low-dose spinal anaesthesia was associated with hypotension of short duration (0.7 ± 1.1 min).
In this study, there was no difference in umbilical cord base deficit between the groups. Larger studies would be required to assess whether the mode of anaesthesia influences the incidence of clinically important neonatal acidosis in neonates with foetal growth restriction.
剖宫产时脊髓麻醉后的低血压可能会降低子宫胎盘灌注，并导致胎儿酸中毒。对于胎儿生长受限和多普勒血流受损的母亲，最佳的麻醉技术尚不清楚。
比较低剂量脊髓麻醉和全身麻醉对新生儿结局和产妇血液动力学的影响。
前瞻性、随机临床试验。
三级保健医院。
40 名患有胎儿生长受限和多普勒血流受损的孕妇，计划行择期剖宫产。
将孕妇随机分配接受低剂量脊髓麻醉（8 毫克布比卡因 0.5%加芬太尼 20μg）或标准全身麻醉行择期剖宫产。使用苯肾上腺素推注维持 SBP 在基础值的 80%至 100%之间。记录低血压的总持续时间、苯肾上腺素的使用剂量以及低血压、恶心或呕吐的任何发生率。
主要观察变量是动脉和静脉脐带基础缺陷。新生儿结局和产妇血液动力学分析为次要终点。
低剂量脊髓麻醉组的脐动脉 pH 值明显低于全身麻醉组（7.23±0.06 与 7.27±0.04，P=0.01）。两组的脐带基础缺陷相似。全身麻醉组的氧分压较高（20.9±6.5kPa），而低剂量脊髓麻醉组较低（13.6±6.1kPa，P=0.001）。两组 1 分钟和 5 分钟 Apgar 评分无差异。全身麻醉组新生儿似乎更需要立即复苏，但差异无统计学意义（P=0.51）。低剂量脊髓麻醉与短暂低血压有关（0.7±1.1 分钟）。
在这项研究中，两组的脐带基础缺陷没有差异。需要更大的研究来评估麻醉方式是否会影响胎儿生长受限新生儿临床重要酸中毒的发生率。
