Abstract
The purpose of this study was to use colour Doppler to determine the effect of epidural anaesthesia on the uterine and umbilical blood flow velocities. After determining the precision of the technique, Doppler insonation of the uterine and umbilical arteries was performed in consenting non-labouring patients requesting epidural anaesthesia for Caesarean section. Patients in Group I were normal and those in Group II were at high risk for uteroplacental blood flow abnormalities. The pulsatility indexes (PI) of both uterine and umbilical arteries were compared at the following times: control, after fluid and after anaesthesia using repeated measure analysis of variance. In Group I (n = 30) the PI increased from 0.72 to 0.82 in the left uterine artery and from 0.71 to 0.85 in the right uterine artery (P < 0.05). In Group II (n = 10) the PI increased from 0.67 to 0.85 in the left uterine artery (NS) and from 0.98 to 1.38 in the right uterine artery (P < 0.05). There was no change in the PI in the umbilical artery. We conclude that the PI of the uterine arteries increases after epidural anaesthesia with lidocaine, epinephrine and fentanyl but there is no change in the umbilical PI. While these changes do not appear to be clinically important in the low-risk population, further studies are required to determine the impact on fetuses at high risk for in utero hypoxaemia.
Résumé
L’objectif de ce travail consiste à utiliser le Döppler en couleur pour évaluer les répercussions de l’anesthésie épidurale sur les vélocités des flux sanguins utérin et ombilical. Après avoir démontré la précision de la technique, le sondage au Döppler des artères utérines et ombilicales est réalisé chez des parturientes programmées pour une césarienne qui sans être en travail ont choisi une épidurale pour l’intervention. Les parturientes du groupé I étaient normales mais celles du groupe II représentaient un risque élevé d’anomalies du débit utéroplacentaire. L’indice de pulsatilité (IP) des artères ombilicale et utérine est comparé aux étapes suivantes: contrôle, après remplissage et après l’anesthésie avec la mesure répétée d’analyse de variance. Dans le groupe I (n = 30), l’IP augmente de 0,72 à 0,82 dans l’artère utérine gauche et de 0,71 à 0,85 dans l’artère utérine droite (P < 0,05). Dans le groupe II (n = 10), l’IP augmente de 0,67 à 0,85 dans l’artère utérine gauche (NS) et de 0,98 à 1,38 dans l’artère utérine droite (P < 0,05). L’IP ne change pas dans l’artère ombilicale. Nous concluons que l’IP des artères utérines augmente après l’anesthésie épidurale avec la lidocaïne, épinéphrine et fentanyl mais que l’IP ombilical ne change pas. Bien que ces changements semblent ne pas d’importance clinique dans une population à faible risque, dans l’avenir, des études seront nécessaires pour déterminer l’impact de l’hypoxémie intrautérine sur le foetus à risque élevé.
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Halpern, S., Glanc, P., Myhr, T. et al. Uterine and umbilical blood flow velocity during epidural anaesthesia for Caesarean section. Can J Anaesth 41, 1057–1062 (1994). https://doi.org/10.1007/BF03015654
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DOI: https://doi.org/10.1007/BF03015654