Abstract
Background/aim Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methodsThis study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block level or ephedrine dose. The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights. The incidence of hypotension and the ephedrine dose were also higher in these subjects. Conclusion SPX values and combined newborn and placenta weights are more predictive of sensory block level than SPF values in parturients receiving spinal anesthesia.
Highlights
Spinal anesthesia is a safe, simple, rapid, effective, and easy-to-apply anesthetic technique for cesarean sections
Sensory block level and ephedrine dose were significantly correlated with the symphysis pubis and the xiphoid (SPX) and the combined newborn and placenta weights (P < 0.05)
The sensory block level was higher for patients who had greater SPX values and higher combined newborn and placenta weights
Summary
Spinal anesthesia is a safe, simple, rapid, effective, and easy-to-apply anesthetic technique for cesarean sections. Many factors including the characteristics of the injected solution, patient position, age, height, weight, pregnancy, intraabdominal pressure (IAP), length of the vertebral column, and lumbosacral cerebrospinal fluid (CSF) volume determine the intrathecal spread of local anesthetics. Physiological changes due to pregnancy, including changes in spinal curvature, venous pooling secondary to progesterone-induced decreases in vascular tone and aortocaval compression by the gravid uterus, contribute to hypotension during cesarean section under regional anesthesia [1,2,3,4,5,6]. Many recent studies have addressed the effects of uterine size, abdominal girth, and IAP on sensory block level, ephedrine dose, and the incidence of hypotension. The primary purpose of this study was to determine whether there is a relationship between uterine size and sensory block level and ephedrine dose in parturients receiving spinal anesthesia. Since Katulanda et al [15] reported that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity, we considered SPX to be a marker of both abdominal obesity and uterine size that contains abdominal obesity, identified anatomical landmarks
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