Abstract
The effect of induction of epidural analgesia with 0.5 per cent bupivicaine on maternal haemodynamics was investigated in 21 patients with uncomplicated full-term pregnancies in early labour. Stroke volume, heart rate, and cardiac output (SV, HR, and CO) were measured by transcutaneous aortovelography (TAV). Systolic, diastolic, and mean arterial blood pressures (SBP, DNP, and MAP) were measured by indirect automatic oscillometry. Measurements were made with the patient in the left lateral decubitus position before and after an intravenous bolus of 500 ml of lactated Ringer’s solution preceding induction of epidural analgesia, and again 30 and 45 minutes after induction. The 500 ml bolus of lactated Ringer’s solution did not prevent fall of CO and BP measured 30 minutes after induction, when there were statistically significant decreases in CO and cardiac index ( -10.2 and -10.6 per cent, p < 0.05), andinSBP,DBP, and MAP (-9.7, -12.5, and -11.9 percent, p > 0.005, p > 0.005 andp > 0.01 respectively). At45 minutes after induction, CO and cardiac index had returned to baseline values. Although the decreases in SDP and DBP persisted, the change in MAP was not statistically significant.
Résumé
Ľeffet de ľinduction de ľanalgésie épidurale avec 0.5 pour cent de bupivacaïne sur Ľhémodynamique maternelle a été investigué chez 21 patientes au début du travail lors ďune grossesse à terme non compliquée. Le volume ďéjection, la fréquence cardiaque, et débit cardiaque (SV, HR, et CO) ont été mesurés par aortovélographie transcutanée (TAV). La pression artérielle systolique et diastolique et moyenne (SBP, DBP, et MAP) ont été mesurées par oscillométrie automatique indirecte. Les mesures ont été faites avec la patiente en décubitus latéral gauche avant et après un bolus intraveineux de 500 ml de lactate Ringer avant ľinduction de ľanalgésie épidurale et aussi 30 et 45 minutes après ľinduction. Ľinjection de 500 ml de solution de lactate Ringer n’a pas empêché la chute du CO et du BP mesurés 30 minutes après ľinduction lorsqu’il y avait une diminution statistiquement significative du CO et de ľindex cardiaque (-10.2 et -10.6 pour cent, p < 0.05), et de la MAP (-11.2 pour cent, p < 0.01). Quarante-cinq minutes après ľinduction, le CO et ľindex cardiaque sont retournés aux valeurs de base et ľévaluation de la MAP n’était pas statistiquement significative.
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Hammond, R.R., Webster, A.C. Haemodynamic effects of induction of epidural analgesia in labour. Can J Anaesth 35, 41–46 (1988). https://doi.org/10.1007/BF03010543
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DOI: https://doi.org/10.1007/BF03010543