The effects of isobaric and hyperbaric bupivacaine on maternal hemodynamic changes after spinal anesthesia for elective cesarean section.
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Date
2018-06
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Addis Ababa Universty
Abstract
Background: The most common local anesthetic used for spinal anesthesia in obstetric and nonobstetric
surgery is bupivacaine that can be used as isobaric or hyperbaric solutions. Cesarean
section is usually performed under spinal anesthesia using hyperbaric bupivacaine which is
associated with an increased incidence of severe hypotension. Isobar bupivacaine is not
commonly used but it could be a good alternative due to having lower maternal hemodynamic
changes than hyperbaric bupivacaine.
Objective: To compare the effects of isobaric and hyperbaric bupivacaine on maternal
hemodynamic changes after spinal anesthesia for elective cesarean section at Gandhi memorial
hospital, Addis Ababa, Ethiopia from December 1 2017 to January 30, 2018.
Methods: Hospital based prospective cohort study design was employed on a total of 100
parturients with a group exposed to isobaric received 12.5 mg of isobaric bupivacaine and
unexposed to hyperbaric group received 12.5 mg of hyperbaric bupivacaine to see the effect on
maternal hemodynamic changes after spinal anesthesia. Study participants were selected by
using systematic random sampling. Symmetric data was analyzed by using independent t-test
and asymmetric data by Mann-Whitney U-test and homogenous categorical data by using chisquare
test. The level of statistical significance for all tests was P < 0.05.
Results: The incidence of hypotension was higher in isobaric than hyperbaric groups (82% vs.
60% respectively; p = 0.015). There was no statistical significant differences in mean arterial
pressure value at baseline, but after spinal anesthesia statistically significant changes were
observed among the groups (p < 0.05) at all study timing, but at 30th min. There was no
statistical significant differences in the mean heart rate variability after spinal anesthesia at all
periods, except at 15th minute (p = 0.033). Higher rate of vasopressor was used in isobaric than
hyperbaric groups (36% vs. 14% respectively; p = 0.011).
Conclusion: Baricity is a significant factor for the maternal hemodynamic changes in parturiants
for elective cesarean section. Isobaric bupivacaine produces higher change in blood pressure and
incidence of hypotension, increase vasopressor requirement than hyperbaric bupivacaine after
spinal anesthesia for elective cesarean section.
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Keywords
isobaric bupivacaine, hyperbaric bupivacaine, maternal hemodynamic changes, elective cesarean section.