Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia

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dc.contributor.advisorDyer, Robert Aen_ZA
dc.contributor.authorDaniels, Abigail Hanliseen_ZA
dc.date.accessioned2018-02-09T07:27:28Z
dc.date.available2018-02-09T07:27:28Z
dc.date.issued2017en_ZA
dc.description.abstractBackground: The maternal haemodynamic responses to vasopressors during spinal anaesthesia for caesarean delivery in patients with severe preeclampsia, have not been accurately described. This study compared the haemodynamic effects of the vasopressors ephedrine and phenylephrine during spinal anaesthesia. Methods: Thirty nine women with treated severe preeclampsia presenting for spinal anaesthesia for caesarean section for a maternal indication, were studied. Baseline maternal haemodynamics were measured in the left lateral position, using minimal invasive cardiac output monitoring (LiDCOrapid). A 300 mL colloid preload was then administered. After standard spinal anaesthesia, 20 patients whose mean arterial pressure decreased to a predetermined target value were randomised to 2 groups of 10, to receive an initial bolus of either 7.5 mg ephedrine or 50 μg phenylephrine, and the haemodynamic responses recorded. The primary outcome was the percentage change in cardiac index. Results: Spinal hypotension in 20 patients was associated with an increase in mean cardiac output from baseline (mean difference 0.7 L/min, p<0.0001). In response to vasopressor, the mean [SD] percentage change in cardiac index was greater, and negative, in patients receiving phenylephrine versus ephedrine (-12 [7.3] vs 2.6 [6] L/min respectively, p=0.0001).] L/min respectively, p=0.0001). Post-vasopressor mean percentage change [SD] in heart rate and systemic vascular resistance (SVR) were higher in patients receiving phenylephrine (-9.1 [3.4] vs 5.3 [12.6], p=0.0027, and 22.3 [7.5] vs -1.9 [10.5] %, p<0.0001 respectively). Conclusions: Phenylephrine effectively reverses spinal anaesthesia-induced haemodynamic changes in severe preeclampsia, if left ventricular function is preserved.en_ZA
dc.identifier.apacitationDaniels, A. H. (2017). <i>Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/27436en_ZA
dc.identifier.chicagocitationDaniels, Abigail Hanlise. <i>"Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017. http://hdl.handle.net/11427/27436en_ZA
dc.identifier.citationDaniels, A. 2017. Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Daniels, Abigail Hanlise AB - Background: The maternal haemodynamic responses to vasopressors during spinal anaesthesia for caesarean delivery in patients with severe preeclampsia, have not been accurately described. This study compared the haemodynamic effects of the vasopressors ephedrine and phenylephrine during spinal anaesthesia. Methods: Thirty nine women with treated severe preeclampsia presenting for spinal anaesthesia for caesarean section for a maternal indication, were studied. Baseline maternal haemodynamics were measured in the left lateral position, using minimal invasive cardiac output monitoring (LiDCOrapid). A 300 mL colloid preload was then administered. After standard spinal anaesthesia, 20 patients whose mean arterial pressure decreased to a predetermined target value were randomised to 2 groups of 10, to receive an initial bolus of either 7.5 mg ephedrine or 50 μg phenylephrine, and the haemodynamic responses recorded. The primary outcome was the percentage change in cardiac index. Results: Spinal hypotension in 20 patients was associated with an increase in mean cardiac output from baseline (mean difference 0.7 L/min, p<0.0001). In response to vasopressor, the mean [SD] percentage change in cardiac index was greater, and negative, in patients receiving phenylephrine versus ephedrine (-12 [7.3] vs 2.6 [6] L/min respectively, p=0.0001).] L/min respectively, p=0.0001). Post-vasopressor mean percentage change [SD] in heart rate and systemic vascular resistance (SVR) were higher in patients receiving phenylephrine (-9.1 [3.4] vs 5.3 [12.6], p=0.0027, and 22.3 [7.5] vs -1.9 [10.5] %, p<0.0001 respectively). Conclusions: Phenylephrine effectively reverses spinal anaesthesia-induced haemodynamic changes in severe preeclampsia, if left ventricular function is preserved. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia TI - Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia UR - http://hdl.handle.net/11427/27436 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/27436
dc.identifier.vancouvercitationDaniels AH. Maternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsia. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/27436en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Anaesthesiaen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherAnaesthesiaen_ZA
dc.titleMaternal and cardiac output response to vasopressor therapy during spinal anaesthesia for Caesarean Section in severe preeclampsiaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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