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Assessment of volume preload on uteroplacental blood flow during epidural anaesthesia for Caesarean section

Published online by Cambridge University Press:  11 May 2005

W. Gogarten ,
D. Struemper ,
H. F. Gramke ,
H. Van Aken ,
H. Buerkle ,
M. Durieux  and
M. A. E. Marcus
W. Gogarten
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
D. Struemper
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
H. F. Gramke
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
H. Van Aken
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
H. Buerkle
Affiliation:
Universitätsklinikum Münster, Department of Anaesthesiology and Intensive Care, Münster, Germany
M. Durieux
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
M. A. E. Marcus
Affiliation:
University Hospital Maastricht, Department of Anaesthesiology and Pain Therapy, The Netherlands
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Extract

Summary

Background and objective: Epidural and spinal anaesthesia are the preferred mode of anaesthesia for Caesarean section. Volume preloading is recommended to prevent maternal hypotension and a reduction in uteroplacental blood flow, although positive effects of volume preloading on maternal cardiac output and arterial pressure are debatable. Doppler measurements of the umbilical artery beyond deriving pulsatility indices are not routinely performed.

Methods: After Institutional Review Board approval and written informed consent, 14 consecutive women with epidural anaesthesia for Caesarean section received either hydroxyethyl starch 500 mL or gelatine 500 mL. Haemodynamic variables monitored were maternal arterial pressure, maximal blood flow velocity and pulsatility indices of the uterine artery derived from Doppler measurements.

Conclusions: Maternal arterial pressure and pulsatility indices in both groups did not change from baseline after intravenous colloid infusion. However, uterine blood flow increased significantly in both groups. The effectiveness of volume preloading may therefore be better described by changes in maximum uterine blood flow velocity than by pulsatility indices or maternal arterial pressure.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, epiduralBLOOD CIRCULATION, regional blood flowECHOCARDIOGRAPHY, DopplerPREGNANCY, feto–maternal exchange
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 5 , May 2005 , pp. 359 - 362
Copyright
© 2005 European Society of Anaesthesiology

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