Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension in Preoperatively Anxious Parturients Underwent Urgent Category-1 Cesarean Section: A Historical Cohort Study

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Şahan C., ŞALVIZ E. A., Alay G. H., Erten Şahan H., Anakli V., TUGRUL K.

Türkiye Kinikleri Anesteziyoloji ve Reanimasyon Dergisi, vol.15, no.2, pp.41-49, 2017 (Peer-Reviewed Journal)


ABSTRACT Objective: This study was designed to investigate the effect of sedation on maternal hypotension

in preoperatively anxious parturients underwent urgent category-1 Cesarean section

(C/S) under spinal anesthesia (SA). Material and Methods: After ethics committee approval, data of

1824 parturients underwent C/S were reviewed from the surgical database and patient charts. Parturients

with high preoperative anxiety scores (VAS-A)≥70) underwent C/S under SA with thiopental

2 mg/kg (if necessary additional 50 mg) sedation until reaching Ramsay sedation score≥3 (Group

S, n=49), and without any other type of sedation (Group NS, n=53) were included in the study. All

parturients received SA with hyperbaric bupivacaine 0.5% 2.5 mL. Hemodynamic parameters

and maximum systolic arterial pressure (SAP) reductions (%) from the baseline were recorded.

Maternal hypotension (SAP≥30% decrease or <100 mmHg) and bradycardia (heart rate <55

beats/min) incidences, required ephedrine (5mg IV bolus) and atropine (0.5 mg IV bolus) doses,

and newborn Apgar scores were also analyzed. Results: Fifty-nine parturients’ data (Group S: 29

and Group NS: 30) were analyzed. The maximum SAP reductions were 23±12.8% and

30.8±16.1% in Groups S and NS, respectively (p=0,044). Hypotension was observed in 5 (17,2%)

parturients of Group S and 15 (50%) of Group NS (p=0.012, 95% CI 0,14-0,82; relative

risk=0,344). Ephedrine requirement was 17±4,4 mg and 25±7,4 mg in Groups S and NS, respectively

(p=0,04). Incidence of bradycardia, required atropine dose and newborn Apgar scores were

similar in both groups (p>0,05). Conclusions: The maximum SAP reduction, hypotension incidence

and required ephedrine doses were lower in thiopental sedation used preoperatively anxious parturients

who underwent category-1 C/S under SA.