Abstract:

Objective To monitor the perioperative circulatory changes in healthy pregnant women undergoing selective cesarean with epidural anesthesia. Methods Fifty-three full-term healthy pregnant women with American Society of Anesthesiologists (ASA)Ⅰ to Ⅱ undergoing selective cesarean with epidural anesthesia were enrolled. Blood pressure, heart rate and pulse oxygen saturation were routinely monitored, and the changes of parameters such as cardiac output were continuously monitored with noninvasive monitoring instrument. The parameters were compared among different time points of baseline (before anesthesia), from satisfactory block level to skin sanitization, gentle fundal massage, fetal disengagement, separation of placenta, 15 min after fetal disengagement, 30 min after fetal disengagement, the end of operation and 2 h after anesthesia. Results There was no significant change in thoracic fluid content during operation （P＞0.05）. The heart rate, left ventricular pumping indexes （stroke volume/stroke volume index, cardiac output/cardiac index）and left ventricular systolic indexes （velocity index, acceleration index, left ventricle ejection time and left cardiac work/left cardiac work index) before and after fetal disengagement were significantly higher than those of baseline and 2 h after anesthesia （P<0.05）. However, the mean arterial pressure, preload and afterload parameters (systemic vascular resistance/systemic vascular resistance index) and left ventricular systolic parameters (pre-ejection period and systolic time ratio) before and after fetal disengagement were significantly lower than those of baseline and 2 h after anesthesia (P<0.05). Conclusion Healthy women undergoing selective cesarean with epidural anesthesia may adapt to circulatory changes by self-compensation and proper anesthetic management.

Key words: anesthesia, epidural, impedance cardiogram, circulatory monitoring, cesarean