Abstract
Purpose
Transport after surgery under spinal anesthesia is associated with cardiovascular changes. The extensively vasodilated patient may be unable to compensate for postural blood flow redistribution. This observational study investigated pre-and post-surgery sensory levels as well as hemodynamic changes during the postoperative transfer period.
Methods
One hundred ninety nine women, ASA 1 and 2, undergoing Cesarean section under spinal anesthesia were studied at the end of surgery. Hyperbaric bupivacaine 12–15 mg and morphine 0.25 mg were the agents used. Patients in group A (n= 111) were transferred to the Recovery Room on a stretcher with the upper body flexed 30° head up: patients in group B (n=88) remained supine during transport.
Results
At the end of Cesarean section 95% of patients had upper sensory levels of T4 and higher. In 17.5% the block ascended 2–7 dermatomes compared with the pre-operative level. The incidence of hypotension on arrival in Recovery Room was similar in both groups (group A 10% and group B 9%).
Conclusion
These results draw attention to the persistence of extensive sympathetic block at the end of Cesarean section. Transport to the Recovery Room was associated with the development of considerable hypotension in 10% of patients and this was unaffected by position. We recommend recording the level of sensory block at the end of surgery and increased monitoring during transport to the Recovery Room.
Résumé
Objectif
Le transport des malades après une opération sous rachianesthésie s’accompagne de modifications cardiovasculares. Une importante vasodilatation ne permet pas de compensation pour la redistribution du débit sanguin postural. La présente étude voulait observer les niveaux sensitifs préopératoire et postopératoire ainsi que les changements hémodynamiques survenus pendant le transfert postopératoire.
Méthode
Il s’est agi de l’observation en fin d’opération de 199 femmes, ASA I et II, ayant subi une césarienne sous rachianesthésie. Les anesthésiques ont été de 12 à 15 mg de bupivacaine hyperbare et 0,25 mg de morphine. Les patientes du groupe A (n = 111) ont été transportées à la salle de réveil sur une civière, le tronc en flexion de 30°; les autres patientes (n = 88) sont demeurées en décubitus dorsal pendant le transfert.
Résultats
À la fin de la césarienne, les niveaux sensitifs supérieurs se situaient à T4 chez 95% des patientes. Chez 17,5%, le blocage neuromusculaire s’est étendu de 2 à 7 dermatomes en comparaison avec le niveau préopératoire. L’incidence d’hypotension à l’arrivée à la salle de réveil a été similaire dans les deux groupes (groupe A, 10%; groupe B, 9%).
Conclusion
Ces résultats devraient attirer notre attention sur la persistance de blocage sympathique étendu à la fin d’une césarienne. Le transfert vers la salle de réveil a été associé au développement d’une importante hypotension chez 10% des patientes et ce, peu importe la position. Nous recommandons de noter le niveau de blocage sensitif à la fin de l’opération et d’accroître la surveillance pendant le transfert à la salle de réveil.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Scull TJ, Carli F. Cardiac arrest after Caesarean section under subarachnoid block. Br J Anaesth 1996; 77: 274–6.
Gambling DR. Cardiac arrest after Caesarean section under subarachnoid block. (Letter) Br J Anaesth 1997; 78: 109–10.
Shnider SM, Levinson G. Anesthesia for Cesarean section.In: Shnider SM, Levinson G (Eds.). Anesthesia for Obstetrics, 3rd ed. Baltimore: Williams & Wilkins, 1993: 211–45.
Mulroy MF. Regional Anesthesia, An Illustrated Procedural Guide, 2nd ed. Boston: Little, Brown & Company, 1996: 60–95.
Bridenbaugh PO, Greene NM. Spinal (subarachnoid) neural blockade.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott, 1998: 233.
Pugh LGC, Wyndham CL. The circulatory effects of high spinal anaesthesia in the hypertensive and control subjects. Clin Sci 1950; 9: 189–203.
Ponhold H, Vicenzi MN. Incidence of bradycardia during recovery from spinal anaesthesia: influence of patient position. Br J Anaesth 1998; 81: 723–26.
De Simone CA, Leighton BL, Norris MC. Spinal anesthesia for Cesarean delivery. A comparison of two doses of hyperbaric bupivacaine. Reg Anesth 1995; 20: 90–4.
Norris MC. Height, weight and the spread of sub-arachnoid hypcrbaric bupivacaine in the term parturient. Anesth Analg 1988; 67: 555–8.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906–16.
Caplan RA, Ward RJ, Posner K, Cheney FW. Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors. Anesthesiology 1988; 68: 5–11
Greene NM, Brull SJ. Physiology of Spinal Anesthesia, 4th ed. Baltimore: Williams & Wilkins, 1993: 14–21.
Stevens RA, Frey K, Liu SS, et al. Sympathetic block during spinal anesthesia in volunteers using lidocaine, tetracaine, and bupivacaine. Reg Anesth 1997; 22: 325–31.
Bengtsson M, Löfström JB, Malmqvist L-A. Skin conductance responses during spinal analgesia. Acta Anaesthesiol Scand 1985; 29: 67–71.
Brull SJ, Greene NM. Time-courses of zones of differencial sensory blockade during spinal anesthesia with hyperbaric tetracaine or bupivacaine. Anesth Analg 1989; 69: 342–7.
Chamberlain DP, Chamberlain BDL. Changes in the skin temperature of the trunk and their relationship to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–43.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bandi, E., Weeks, S. & Carli, F. Spinal block levels and cardiovascular changes during post-Cesarean transport. Can J Anesth 46, 736–740 (1999). https://doi.org/10.1007/BF03013908
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03013908