제왕절개술에서 수술 전 심박수 증가와 척추 마취 후 혈압 저하의 연관성 (Preoperative increased heart rate is related to the blood pressure decrease during spinal anesthesia for cesarean delivery)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Anesthesia and Pain Medicine / 7권 / 1호 / 71 ~ 75페이지
· 저자명 : 이해광, 황정원, 김준식, 민경범, 송인애, 유정희, 전영태, 도상환

초록

Background: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia.
Methods: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37weeks. In the supine position, noninvasive blood pressure (BP)and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done.
Hyperbaric bupivacaine 8 mg and fentanyl 15 μg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (＜80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min).
Results: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P ＜ 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs.
83%, P = 0.014).
Conclusions: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.

영어초록

Background: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia.
Methods: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37weeks. In the supine position, noninvasive blood pressure (BP)and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done.
Hyperbaric bupivacaine 8 mg and fentanyl 15 μg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (＜80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min).
Results: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P ＜ 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs.
83%, P = 0.014).
Conclusions: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.

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