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Implementing skin-to-skin contact following cesarean section improves cerebral hemoglobin saturation levels measured by Near Infrared Spectroscopy.
Abstract Number: SU-74
Abstract Type: Case Report/Case Series
A 33 years old previously healthy parturient, G4P3CS0, was admitted for a scheduled cesarean delivery. The parturient was taken to the operation room, connected to standard ASA monitoring. Spinal anesthesia (SA) was performed, using bupivacaine 12 mg, fentanyl 20 µg and morphine 0.1 mg with a prophylactic phenylephrine infusion of 50 µg/min from beginning of SA to the end of surgery. Immediately after delivery, oxytocin 20 units was injected into a liter of Ringer Lactate and infused. No other uterotonics were given. Following the delivery an immediate skin-to-skin contact was implemented until the end of surgery. In addition right and left-sided brain saturation measurement was used via Near Infrared Spectroscopy (INVOS Cerebral/Somatic Oximeter|Covidien)- a direct non-invasive measurement of blood oxygenation in the brain microvasculature that has shown a high level of accuracy and can be used to detect an index of brain oxygenation (1). The measurements were made at the following points: baseline in supine position, in the sitting position, during local anesthesia, at the end of SA, 1 minute, 5 minutes after anesthesia, at the skin incision, after neonate extraction, 1 minute after beginning of oxytocin infusion, at the end of skin closure, 1 hour after surgery. The surgery was uneventful and took 36 minutes. After the surgery the parturient was monitored at PACU for another 2 hours (hospital protocol). After the spinal block there was no decrease in cerebral saturation, right and left-sided, compared to the baseline. After implementation of skin to skin, there was a gradual increase in cerebral saturation on both sides, with a maximum level at the end of surgery (69% versus 45% baseline left-sided; 79% versus 47% baseline right-sided). One hour after surgery there was decrease in cerebral saturation, but not below the baseline (see figure 1). The changes of brain saturation were not correlated with blood pressure changes that remained within normal limits through the perioperative period.
Discussion: It seems that spinal block causes a decrease in cerebral saturation. This effect is also seen in a prospective study which is now being done in our hospital. A decrease is partially reversed by parturient's excitation because of contact with baby. More researches are required to further investigate this phenomenon.
1)Near-infrared spectroscopy as an index of brain and tissue oxygenation.Murkin JM, Br J Anaesth.,2009