Anesthesia, Spinal, Cesarean Section, Echocardiography, Cardiac Output
Conditions
Brief summary
Cardiac output will be measured in healthy parturients undergoing cesarean delivery under spinal anesthesia
Detailed description
ASA-II women undergoing cesarean delivery under spinal anesthesia will be included. Cardiac output will be measured using transthoracic echocardiography at 4 time points: Baseline, after 10 minutes of intrathecal injection, after delivery, and after 1 hour of intrathecal injection. Spinal anesthesia will be administered with 2.5 ml bupivacaine 0.5% and fentanyl 15 μg.
Interventions
RADIATIONTransthoracic Echocardiography
Measurement of cardiac output in supine position with left lateral tilt at baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection
PROCEDURESpinal Anesthesia
Performed at the L3-L4 or L4-L5 interspace using 25-gauge spinal needle
Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space
Fentanyl 15 μg will be administered in the subarachnoid space
Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection
PROCEDURECesarean Delivery
Lower segment cesarean section using the Pfannenstiel incision and uterine exteriorization
Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 90%, 80%, and 70% of baseline, respectively.
DRUGOxytocin
Intravenous oxytocin 10 U in 500 mL Ringer acetate will be administered over 30 minutes starting immediately after delivery of the fetus
Sponsors
Mansoura University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
19 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* American Society of Anesthesiologists physical status II parturients. * Full term, singleton pregnancy * Elective cesarean delivery under spinal anesthesia
Exclusion criteria
* Height \<150 cm * Weight \<60 kg * Body mass index (BMI) \<18.5 or ≥ 35 kg/m² * Women presenting in labor * Contraindications to spinal anesthesia: increased intracranial pressure, coagulopathy, or local skin infection * Hemoglobin \<10 g/dL * Current administration of vasoactive drugs (e.g., salbutamol, thyroxin) * Diabetes mellitus, cardiovascular, or renal disease * Chronic or pregnancy-induced hypertension * Polyhydramnios * Women with high risk for postpartum hemorrhage or uterine atony (e.g., placenta accreta spectrum, ≥3 previous cesarean deliveries)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in cardiac output | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection | Cardiac output measured using transthoracic echocardiography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in heart rate | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection | — |
| Number of subjects requiring ephedrine | From intrathecal injection to the end of cesarean delivery | — |
| Incidence of hypotension | From intrathecal injection to the end of cesarean delivery | Systolic blood pressure \<80% of baseline |
| Changes in stroke volume | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection | — |
| Incidence of bradycardia | From intrathecal injection to the end of cesarean delivery | Heart rate \<50 beats/min |
| Incidence of nausea and/or vomiting | From intrathecal injection to the end of cesarean delivery | — |
| Neonatal Apgar scores | At 1 and 5 minutes after delivery | — |
| Incidence of severe hypotension | From intrathecal injection to the end of cesarean delivery | Systolic blood pressure \<70% of baseline |
Countries
Egypt
Outcome results
None listed