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Correspondence| Volume 20, ISSUE 3, P268-269, July 2011

Is a relatively high pre-spinal heart rate associated with reduced efficacy of prophylactic vasopressor during spinal anaesthesia for caesarean section?

Published:June 06, 2011DOI:https://doi.org/10.1016/j.ijoa.2011.04.002
Is a relatively high pre-spinal heart rate associated with reduced efficacy of prophylactic vasopressor during spinal anaesthesia for caesarean section?
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      There is evidence from studies of heart rate variability that relatively high levels of sympathetic activity before spinal anaesthesia are associated with lower minimum absolute values for systolic arterial pressure (SAP) during spinal anaesthesia for caesarean section.
      • Hanss R.
      • Bein B.
      • Ledowski T.
      • et al.
      Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery.
      Anesthesiology. 2005; 102: 1086-1093
      , 
      • Hanss R.
      • Bein B.
      • Francksen H.
      • et al.
      Heart rate variability-guided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery.
      Anesthesiology. 2006; 104: 635-643
      , 
      • Chamchad D.
      • Arkoosh V.A.
      • Horrow J.C.
      • et al.
      Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia.
      Anesth Analg. 2004; 99: 1818-1821
      Two studies have also observed that a relatively high pre-spinal heart rate is associated with lower minimum values for SAP, expressed as a proportion of baseline, during spinal anaesthesia.
      • Chamchad D.
      • Arkoosh V.A.
      • Horrow J.C.
      • et al.
      Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia.
      Anesth Analg. 2004; 99: 1818-1821
      , 
      • Frolich M.A.
      • Caton D.
      Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetrical patients.
      Can J Anesth. 2002; 49: 185-189
      A prophylactic vasopressor was not used in these studies. We have re-examined data from a previous study of women undergoing spinal anaesthesia for caesarean section,
      • Cooper D.W.
      • Carpenter M.
      • Mowbray P.
      • Desira W.R.
      • Ryall D.M.
      • Kokri M.S.
      Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.
      Anesthesiology. 2002; 97: 1582-1590
      to assess whether differences in pre-spinal heart rate are associated with differences in the minimum value for SAP when a prophylactic vasopressor is given.
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      References

        • Hanss R.
        • Bein B.
        • Ledowski T.
        • et al.
        Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery.
        Anesthesiology. 2005; 102: 1086-1093
        View in Article
        • Hanss R.
        • Bein B.
        • Francksen H.
        • et al.
        Heart rate variability-guided prophylactic treatment of severe hypotension after subarachnoid block for elective cesarean delivery.
        Anesthesiology. 2006; 104: 635-643
        View in Article
        • Chamchad D.
        • Arkoosh V.A.
        • Horrow J.C.
        • et al.
        Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia.
        Anesth Analg. 2004; 99: 1818-1821
        View in Article
        • Frolich M.A.
        • Caton D.
        Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetrical patients.
        Can J Anesth. 2002; 49: 185-189
        View in Article
        • Cooper D.W.
        • Carpenter M.
        • Mowbray P.
        • Desira W.R.
        • Ryall D.M.
        • Kokri M.S.
        Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery.
        Anesthesiology. 2002; 97: 1582-1590
        View in Article

      Article info

      Publication history

      Published online: June 06, 2011
      Accepted: April 12, 2011

      Identification

      DOI: https://doi.org/10.1016/j.ijoa.2011.04.002

      Copyright

      © 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.

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