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Comparison of hemodynamic effects of different baricities ropivacaine in combined spinal epidural anesthesia for cesarean delivery.
Abstract Number: F-50
Abstract Type: Original Research
Background The baricities of ropivacaine during induction of combined spinal-epidural anesthesia(CSEA) may have a different effect on maternal hemodynamics and block characteristics. We used a non-invasive cardiac output monitor to compare the effect of different baricities of ropivacine during CSEA for cesarean delivery
Methods 92 American Society of Anesthesiologists physical status I or II parturients scheduled for elective cesarean delivery were randomized into three groups: Hypobaric, isobaric and hyperbaric groups. CSEA was performed midline at the L3-4 interspace. All patients received different baricities of ropivacaine. LiDCOrapid Pulse contour Analysis System was used to monitor the hemodynamic change. The primary outcome was the hemodynamic changes and the block characteristics during the study period. Secondary outcomes included the onset time, side effects and neonatal outcomes.
Results Patient characteristics were similar in all groups. Cardiac output (CO), stroke volume(SV), heart rate(HR) were increased while systemic vascular resistance (SVR) and mean arterial pressure(MAP) were decreased in all groups. Compared to the hypobaric and isobaric groups, hyperbaric group had a significantly higher HR(P=0.012)，lower SVR(P=0.002) and lower MAP(P<0.001). Time to achieved the T8 level was significantly shorter in hyperbaric group (2.4±1.1min, 95%CI,2.0-2.8) than in hypobaric group(10.2±4.2min, 95%CI 8.6-11.9) and isobaric(10.6±4.0min, 95%CI 9.1-12)(P<0.05). All patients in hyperbaric group developed adequate levels while there was 55% hypobaric group and 67% isobaric group failed to achieve T8 sensory level and required an epidural supplement of 0.5% ropivacaine, which consumed 33±35mg and 33±28mg respectively. The time of induction to skin incision was significantly shorter in Group C(11.6±2.1min) than in Group A(14.2±4.4min) and Group B(13.5±4.3min)(P<0.05). There was no significant difference in the incidence of hypotension, nausea, vomiting and the neonatal outcomes among groups.
Conclusions We demonstrated that hyperbaric ropivacaine provided adequate and dependable anesthesia for cesarean delivery, due to its better anesthetic effect and controllability with the advantage of rapid onset time and stable hemodynamic effect.