Prevention of arterial hypotension during cesarean section under spinal anesthesia: trial of a baby norepinephrine protocol at the Owendo University Hospital Center (Gabon)

M. Jm, Matsanga A, Obame R, N. Pc, Ifoudji Makao A, S. Lv, Sima Zué A
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Abstract

Spinal anesthesia is a commonly used technique in cesarean section. This technique causes frequent maternal hypotension responsible for a reduction in placental perfusion rate causing fetal acidosis. Prophylactic vasopressor treatment is systematically recommended. Noradrenaline is today a molecule of choice. The objective of this work was to describe the benefit of using baby norepinephrine in the prevention of arterial hypotension in the context of cesarean section under spinal anesthesia. Methodology: Through a prospective observational study, parturients undergoing a planned or relative emergency cesarean section under spinal anesthesia during this period were included. Norepinephrine was administered by slow venous infusion at a rate of 0.028 to 0.057, or 4 to 10 drops/minute. Results: During the study period, 28 women were included. Their mean age was 30.1 ± 5.6. Scarred uterus (32%) and narrowed pelvis (25%) were the main indications. Parturients were classified according to the American Society of Anesthesia (ASA) as ASA1 in 82.1%. The systolic blood pressure recorded after the start of the baby norepinephrine infusion at the 1st minute, between the 5th and 15th minutes and between the 15th and 30th respectively between 100 and 140 mmHg in 71.4%, 85.7 % and 96.4% cases. Heart rate remained normal throughout norepinephrine administration. Conclusion: Low-dose norepinephrine ensures good hemodynamic stability perioperatively for cesarean section under spinal anesthesia.
预防脊髓麻醉下剖腹产术中的动脉低血压:在奥文多大学医院中心(加蓬)试用婴儿去甲肾上腺素方案
脊髓麻醉是剖腹产手术中常用的技术。这种技术会导致产妇经常性低血压,从而降低胎盘灌注率,引起胎儿酸中毒。因此系统性地推荐使用预防性血管加压治疗。如今,去甲肾上腺素已成为首选分子。本研究旨在描述在脊髓麻醉下进行剖宫产手术时使用婴儿去甲肾上腺素预防动脉低血压的益处。研究方法:通过前瞻性观察研究,纳入在此期间接受脊柱麻醉下计划剖宫产或相对紧急剖宫产的产妇。以 0.028 至 0.057 或 4 至 10 滴/分钟的速度缓慢静脉输注去甲肾上腺素。研究结果在研究期间,共纳入了 28 名女性。她们的平均年龄为 30.1±5.6 岁。瘢痕子宫(32%)和骨盆狭窄(25%)是主要适应症。根据美国麻醉学会(ASA)的分类,82.1%的产妇属于ASA1级。婴儿去甲肾上腺素输注开始后第1分钟、第5分钟至第15分钟、第15分钟至第30分钟的收缩压分别为100至140毫米汞柱(71.4%、85.7%和96.4%)。在整个去甲肾上腺素输注过程中,心率保持正常。结论小剂量去甲肾上腺素可确保脊髓麻醉下剖宫产术围手术期良好的血流动力学稳定性。
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