Líquidos y vasopresores en prevención y manejo de hipotensión inducida por anestesia espinal durante cesárea programada en mujeres colombianas
Líquidos y vasopresores en prevención y manejo de hipotensión inducida por anestesia espinal durante cesárea programada en mujeres colombianas
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Introducción: durante operación cesárea, el principal efecto colateral de la anestesia espinal es la hipotensión inducida por anestesia espinal (HIAE).
Objetivo: identificar las conductas en cuanto al uso de líquidos y vasopresores, para la prevención y manejo de la HIAE durante cesárea en mujeres sanas. Metodología: se realizó encuesta vía correo electrónico a los miembros de la Sociedad Colombiana de Anestesiología y Reanimación (SCARE) en abril de 2012 con el fin de determinar sus estrategias para prevención y manejo de la HIAE en cuanto al uso de líquidos y vasopresores. Encuesta creada por los autores y sin proceso de validación.
Resultados: 491 anestesiólogos de los 2113 (23.2%), respondieron la encuesta. El 61.7% de los participantes utilizaban solamente líquidos como estrategia de prevención de la HIAE. De ellos, el 60% lo administraba solo como precarga y el resto como cocarga. El 10.2% de todos los participantes combinaba líquidos endovenosos y vasopresores. El 3.7% utilizaba solo vasopresores y el 24.4% no utiliza ninguna de esas medidas como prevención de la HIAE. Los cristaloides fueron usados por más del 99% de los encuestados que administran líquidos rutinariamente, siendo la dosis de preferencia entre 500 y 1000 cc. Solo el 14% de los encuestados usa vasopresores en forma profiláctica, de los cuales el 53% usa etilefrina, la mayoría en forma de bolo endovenoso. La mayoría de los encuestados usa vasopresores solo en forma terapéutica, siendo preferida por el 65% la etilefrina, seguido por la efedrina, ambos administrados principalmente en forma de bolos endovenosos.
Conclusión: la etilefrina es el agente más utilizado por un grupo de anestesiólogos
colombianos pertenecientes a la SCARE, principalmente en forma de bolos endovenosos,
como medida profiláctica y terapéuticamente para la HIAE en operación cesárea. Rev.
cienc.biomed. 2014;5(2):263-271.
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Rout CC, Rocke DA. Prevention of hypotension following spinal anesthesia for Cesarean section. Int Anesthesiol Clin. 1994;32:117-35.
Birnbach DJ, Soens MA. Hotly debated topics in obstetric anesthesiology 2008: a theory of relativity. Minerva Anestesiol. 2008;74:409-24.
Park GE, Hauch MA, Curlin F, Datta S, Bader AM. The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure.
Anesth Analg. 1996;83:299-03.
Marx GF, Cosmi EV, Wollman SB. Biochemical status and clinical condition of mother and infant at cesarean section. Anesth and Analg.1969;48:986-93.
Levin A, Datta S, Segal S. The effect of posture on hypotension after spinal anesthesia for cesarean section. Anesthesiology. 1998;88:10-15.
Kennedy RL, Friedman DL, Katcka DM, Selmants S, Smith RN. Hypotension during obstetrical anesthesia. Anesthesiology. 1959;20:153-55.
Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose
versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008;109:856-63.
Rocke DA, Rout CC. Volume preloading, spinal hypotension and caesarean section. British J of Anaesthesia. 1995;75(3):257-59.
Karinen J, Räsänen J, Alahuhta S, Jouppila R, JouppilaP. Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean
section. Br J Anaesth.1995;75:531-35.
Vercauteren MP, Hoffmann V, Coppejans HC, Van Steenberge AL, Adriaensen HA. Hydroxyethylstarch compared with modified gelatin as volume preload before spinal anaesthesia for caesarean
section. Br J Anaesth. 1996;76:731–3.
Banerjee A, Stocche R, Angle P, Halpern S. Preload or coload for spinal anesthesia for elective cesarean delivery: a meta-analysis. Can J Anesth. 2010;57:24–31.
Dyer RA, Farina Z, Joubert BA. Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section. Anaesth Intensive Care.
;32(3):351-57.
Teoh W, Sia A; FANZA. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg. 2009;108:1592-98.
Lawes EG. Volume preloading, spinal anaesthesia and caesarean section. Br J Anaesth. 1996;76:334-35.
Ngan WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery.
AnesthAnalg. 2000;90:1390–5.
Vercauteren MP, Coppejans HC, Hoffmann VH, Mertens E, Adriaensen HA. Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. AnesthAnalg. 2000;90:324-27.
Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinalanaesthesia for
caesarean section. Br J Anaesth. 1996;76:61-5.
Smiley RM, Blouin JL, Negron M, Landau R. Beta2-adrenoceptor genotype affects vasopressor requirements during spinal anesthesia for cesarean delivery. Anesthesiology. 2006;104:644-50.
Ngan WD, Lau TK, Khaw KS, Lee BB. Comparison of metaraminol and ephedrine infusions for maintaining arterial pressure during spinal anesthesia for elective cesarean section.
Anesthesiology. 2001;95:307-13.
Vercauteren MP, Coppejans HC, Hoffmann VL, Saldien V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarean section. AnesthAnalg.
;86:989-93.
Bryson GL, Macneil R, Jeyaraj LM, Rosaeg OP. Small dose spinal bupivacaine for cesarean delivery does not reduce hypotension but accelerates motor recovery. Can J Anaesth.
;54:531-37.
Qian XW, Chen XZ, Li DB. Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomized trial. Int J ObstetAnesth. 2008;17:309-14.
Cesur M, Alici HA, Erdem AF, Borekci B, Silbir F. Spinal anesthesia with sequential administration of plain and hyperbaric bupivacaine provides satisfactory analgesia with hemodynamic
stability in cesarean section. Int J ObstetAnesth. 2008;17:217-22.
Clark SL, Cotton DB, Pivarnik JM, Lee W et al. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am J Obstet Gynecol. 1991;164(3):883-87.
Miyabe M, Sato S. The effect of head-down tilt position on arterial blood pressure after spinal anesthesia for cesarean delivery. RegAnesth. 1997;22:39-42.
Tsen L. Anesthesia for cesarean delivery. En: Chesnutt DH, Wong CA, Tsen LC, Ngan WD, Bellin Y, Mhyre JM, eds. Obstetric anesthesia: principles and practice. Philadelphia: Elsevier Mosby, 2009;26:521-73.
Ngan KW, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: an effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103:744-50.
Bouchnak M, Ben Cheikg N, Skhiri A, Yaacoubi M, menif MA, Smaoui M, et al. Relevance of rapid crystalloid administration after spinal anaesthesia (coload) in prevention of hypotension
during elective caesarean section:A-685. Eur J Anaesthesiol. 2006;23:178.
Mercier FJ, Bonnet MP, De la Dorie A, Moufouke M, Hanaf A,Edouard D, et al. Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension. Ann FrAnesthReanim.
;26:688-93.
Hughes S C, Ward M G, Levinson G, Shnider S, Wright R, Gruenke L, et al. Placental transfer of ephedrine does not affect neonatal outcome. Anesthesiology. 1985;63:217–19.
James III F M, GreissJr F C, Kemp R A. An evaluation of vasopressor therapyfor maternal hypotension during spinal anesthesia. Anesthesiology. 1970;33:25-34.
Ralston D H, Shnider S M, DeLorimier A A. Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnant ewe. Anesthesiology.
;40:354-70.
Ducros L, Bonnin P, Cholley B, Vicaut E, Benayed M, Jacon D, et al. Increasing maternal blood pressure with ephedrine increases uterine artery blood flow velocity during uterinecontraction.
Anesthesiology. 2002;96:612-16.
LaPorta RD, Arthur GR, Datta S. Phenylephrine in treating maternal hypotension due to spinkal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations,
acid base status and apgar scores. Acta Anaesthesiol Scand. 1995;39:901–5.
Ngan WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. CurrOpinAnaesthesiol. 2010;23:304-9
Veeser M, Hofmann T, Roth R, Klöhr S, Rossaint R, Heesen M. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anesthesiol Scand. 2012; 56(7):810-6. doi: 10.1111/j.1399-6576.2011.02646.x
Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under
spinal anesthesia. AnesthAnalg. 2012;114(2):377-90.
Braveman FR, Scavone BM, Wong CA, Santos AC. Obstetric anesthesia. En: Barash PG, Cullen BF, Stoelting RK, eds. Clinical anesthesia, 6th Edn. Philadelphia: Lippincott Williams
& Wilkins, 2006; 1137–1370.
De Simone CA, Leighton BL, Norris MC. Spinal anesthesia for caesarean delivery. A comparison of two doses of hyperbaric bupivacaine. Regional Anesthesia. 1995;20:90-94.
Arzola C, Wieczorek PM. Efficacy of low dose bupivacaine in spinal anaesthesia for caesarean delivery: systematic review and meta-analysis. British Journal of Anaesthesia. 2011;107:308-18.
Carvalho B, Collins J, Drover DR, Atkinson L, Riley ET. ED50 and ED95 of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology. 2011;114:529-
Lee Y, Balki M, Parkes R, Carvalho JC. Dose requirement of intrathecal Bupivacaine for cesarean delivery is similar in obese and normal weight women. Rev Bras Anestesiol. 2009;59:674-83.
Lirk P, Halle I, Benze A, Wong CA. Management of spinal anaesthesia-induced hypotension for cesarean delivery: a European Survey. Eur J Anaesthesiol. 2012;29(9):452-3.
Burns SM, Cowan CM, Wilkes RG. Prevention and management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice. Anaesthesia 2001;56:794–
Sertznig C, Vial F, Audibert G, Merte PM, El Adssi H, Bouaziz H. Management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice in Lorraine region.
Ann FrAnesthReanim. 2011;30(9):630-635.
Allen TK, Muir HA, George RB, Habib AS. A survey of the management of spinal-induced hypotension for scheduled cesarean delivery. Int J Obstet Anesth. 2009;18:356-61.
Rout C C, Rocke DA. Levin J. Gouws E. Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean
section. Anesthesiology. 1993;79:262-69.
Jackson R, Reid J A, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. Br J Anaesth. 1995:75:262-65.
Ueyama H, He YL, Tanigami H Mashimo T, Yoshida I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section.
Anesthesiology. 1999;91:1571-76.
Pouta AM, Karinen J, Vuolteenaho OJ, Laatikainen TJ. Effect of intravenous fluid preload on vasoactive peptide secretion during caesarean section under spinal anaesthesia. Anaesthesia.
; 51(2):128-32.
Suga S, Nakao K, Itoh H, Komatsu Y, Hama N, Imura H, et al. Endothelial production of Ctype natriuretic peptide and its marked augmentation by transforming growth factor-beta.
Possible existence of ‘‘vascular natriuretic peptide system’’. J Clin Invest. 1992;90(3):1145-49.
Shin BS, Ko JS, Gwak MS, Yang M, Kim Ch, Hahm T, et al. The effects of prehydration on the properties of cerebrospinal fluid and the spread of isobaric spinal anesthetic drug. Anesth Analg. 2008;106:1002-07.
Hahn RG, Svensén C. Plasma dilution and the rate of infusion of Ringer’s solution. Br J Anaesth. 1997;79:64-7.
Hahn RG, Resby M. Volume kinetics of ringer’s solution and dextran 3% during induction of spinal anaesthesia for caesarean section. Can J Anaesth. 1998;45:443-51.
Tamilselvan P, Fernando R, Bray J, Sodhi M, Columb M. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal
anesthesia: a randomized trial. AnesthAnalg. 2009;109:1916-21.
Madi-Jebara S, Ghosn A, Sleilaty G, Cherfane A, Yazigi A, Antakly MC. Prevention of hypotension after spinal anesthesia for cesarean section: 6% hydroxyethyl starch 130/0.4 (Voluven)
versus lactated Ringer’s solution. J Med Liban. 2008;56:203-7.
Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood Volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. AnesthAnalg.
;92:997-1005.
Coleman A J, Leary W P, Asmal AC. The cardiovascular effects of etilefrine. Eurp.J.Clin.Pharmacol. 1975;8:41-45.
Stanton-Hicks M, Höck A, Stühmeier K-D, Arndt JO. Venoconstrictor agents mobilize blood from different sources and increase intrathoracic filling during epidural anesthesia in supine
humans. Anesthesiology.1987;66(3):317-22.
Montoya BH, Oliveros CI, Moreno DA. Manejo de la hipotensión inducida por anestesia espinal para cesárea. Rev. colombiana anestesiol. 2009;37(2):131-5.
Räsänen J, Alahuhta S, Kangas-Saarela T, Jouppila R, Jouppila P. The effects of ephedrine and etilefrine on uterine and fetal blood flow and of fetal myocardial function during spinal anaesthesia for caesarean section. Int J ObstctAnaesth.1991;1(1):3-8.
Trudinger B J, Giles W B, Cook C M. Flow velocity waveforms in the maternal uteroplacental and fetal umbilical placental circulations. Am J ObstetGynecol. 1985;151(2):155-63.
Ngan WD, Khaw KS, Tan PE, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009;111(3):506-12.
Riley ET. Spinal anesthesia for caesarean delivery: keep the pressure up and don’t spare the vasoconstrictors. Br. J. Anaesth. 2004;92(4):459-61.
Ngan WD, Lee A. Multivariate analysis of factors associated with umbilical arterial pH and standard base excess after caesarean section under spinal anaesthesia. Anaesthesia.
;58(2):125-30.
Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002;97(6):1582-90.
Wright RG, Shnider SM, Levinson G, Rolbin SH, Parer JT. The effect of maternal administration of ephedrine on fetal heart rate and variability. Obstet Gynecol. 1981;57(6):734-38.
Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. BMJ. 2010;340:c1471.
Langesæter E, Dyer RA. Maternal haemodynamic changes during spinal Anaesthesia for caesarean section. Curr Opin Anaesthesiol. 2011;24(3):242-8.
Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal
anesthesia for elective cesarean delivery. Anesthesiology. 2009;111(4):753-65.
Macarthur A, Riley ET. Obstetric anesthesia controversies: vasopressor choice for post spinal hypotension during cesarean delivery. Int Anesthesiol Clin. 2007;45(1):115-32.
Moran DH, Perillo M, LarPorta RF, Bader AM, Datta S. Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth. 1991;3(4):301-5.
Smiley RM. Burden of proof. Anesthesiology. 2009;111:470-72.
Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database of Systematic Reviews.
;(4):CD002251.
