Perioperative Hemodynamic Response and Vasopressor Requirement During Spinal Anaesthesia for Cesarean Section in Healthy and Pre-Eclamptic Patients

OBJECTIVE To assess hemodynamic response and vasopressor  requirement  during spinal  anaesthesia for cesarean section in healthy and Pre-eclamptic patients. To assess neonatal outcome using APGAR scores. INTRODUCTION In normal pregnancy, there is increased synthesis of prostaglandins (PGs) and nitric oxide, which act as vasodilators. Maintanance of vascular tone is highly dependent on sympathetic vasoconstriction. Immediately after spinal anaesthesia there is high degree of fall in BP. METHODS We enrolled a total 60 patients, 30 healthy (control group) and 30 Pre-eclamptic (BP > 140/90 mmHg) parturients (study group) above 20 years of age, undergoing elective cesarean section in the study. After preloading with 10 ml/kg of ringer lactate solution, spinal anesthesia was given with 10 mg of hyperbaric bupivacaine. Systolic blood pressure (SBP), Diastolic blood pressure( DBP), Mean arterial pressure (MAP) and heart rate(HR) were recorded. Apgar score was noted at 1 and 5 min after birth. Mephenterimine administered in 6 mg bolus dose when MAP decreased more than 20% of baseline.  RESULT The number of episodes of hypotension was more in normotensive group as compared to pre-eclamptic patients. Neonatal outcome was also comparable. DISCUSSION: In pre-eclampsia, there is increased amount of endogenous vasopressors like thromboxane and endothelin, because of which pre-eclamptics tend to maintain their vascular tone after spinal anaesthesia as compared to  healthy patients. This prevents excessive fall in Blood pressure . CONCLUSION:  Pre-eclamptic patients are more hemodynamically stable, with reduced need of vasopressor under spinal anesthesia.Neonatal outcome was comparable and good in both the groups in respect to Apgar score at 1 and 5 min after birth .

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