Abstract
Purpose: Spinal block has long been considered a safe anesthesia technique for surgery. However, severe brady-cardia, cardiac arrest, and other arrhythmias during spinal anesthesia have been reported and the incidence of intraoperative arrhythmias is not well established. In this study the incidence of arrhythmias during spinal anesthesia was determined.
Methods: We studied 254 healthy women undergoing Cesarean section under spinal anesthesia prospectively. Spinal anesthesia with 10 mg bupivacaine mixed with 0.2 mg morphine was performed at the L3–4 interspace. Intraoperative arrhythmias were recorded and verified later by a cardiologist.
Results: First degree atrioventricular block developed in nine patients (3.5%), second degree atrioventricular block in nine (3.5%), severe bradycardia (heart rate <50 beats·min−1) in seventeen (6.7%), multiple VPC in three (1.2%). The height and weight of patients with severe bradycardia, multiple VPCs, or atrioventricular block were not different from those of the other patients. However, the age of patients in the potentially dangerous arrhythmias group was greater than that in the other group (P=0.006).
Conclusion: The incidence of arrhythmias as well as hypotension during spinal anesthesia for Cesarean section was higher than expected. Although most of these arrhythmias were transient and recovered spontaneously, they might unexpectedly occur and sometimes need immediate and prompt treatment. It is necessary to remain vigilant during spinal anesthesia for Cesarean section and careful monitoring of these patients is warranted, especially in older parturients.
Résumé
Objectif: On a longtemps considéré la rachianesthésie comme une technique sécuritaire pour la chirurgie. Cependant, des cas de bradycardie sévère, d’arrêt cardiaque et d’autres arythmies ont été signalés pendant la rachianesthésie et l’incidence d’arythmie peropératoire n’est pas bien définie. Dans la présente étude, on a déterminé l’incidence d’arythmie pendant la rachianesthésie.
Méthode: Nous avons fait l’étude prospective de 254 femmes en santé qui ont subi une césarienne sous rachianesthésie. L’injection de 10 mg de bupivacaïne avec 0,2 mg de morphine a été réalisée dans l’espace L3–4. L’arythmie peropératoire a été notée et vérifiée ensuite par un cardiologue.
Résultats: Un bloc auriculoventriculaire de premier degré s’est développé chez neuf patientes (3,5 %), un bloc de second degré chez neuf patientes également (3,5 %), une bradycardie sévère (fréquence cardiaque <50 battements·min−1) chez dix-sept (6,7 %), de multiples ESV chez trois (1,2 %). La grandeur et le poids des patientes qui ont présenté une bradycardie sévère, de multiples ESV ou un bloc auriculoventriculaire ne différaient pas de ceux des autres patientes. Toutefois, les patientes du groupe présentant des arythmies potentiellement dangereuses étaient plus âgées que les autres (P=0,006).
Conclusion: L’incidence d’arythmie autant que d’hypotension pendant la rachianesthésie pour une césarienne a été plus élevée que prévu. Même si la plupart de ces arythmies ont été transitoires et sont disparues spontanément, elles peuvent survenir inopinément et exiger parfois un traitement rapide et immédiat. Cette situation appelle à la vigilance et au monitorage suivi de ces patientes, justifié surtout chez les parturientes plus âgées.
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Financial support was received from the Research Foundation of Ton Yen General Hospital, Taiwan.
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Shen, CL., Ho, YY., Hung, YC. et al. Arrhythmias during spinal anesthesia for Cesarean section. Can J Anaesth 47, 393–397 (2000). https://doi.org/10.1007/BF03018966
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DOI: https://doi.org/10.1007/BF03018966