Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Anesthesia
Published in: Journal of Anesthesia 4/2016

01-08-2016 | Original Article

Relationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section

Authors: Noriya Hirose, Yuko Kondo, Takeshi Maeda, Takahiro Suzuki, Atsuo Yoshino

Published in: Journal of Anesthesia | Issue 4/2016

Login to get access

Abstract

Purpose

During spinal anesthesia for cesarean section, cerebral oxygenation decreases may be related to an abrupt drop in cerebral blood flow due to hypotension. We measured the changes in maternal regional cerebral blood volume (rCBV) and oxygenation (rCBO) using near-infrared spectroscopy (NIRS) to evaluate whether a decrease in arterial blood pressure during spinal anesthesia diminishes rCBV and rCBO.

Methods

Forty patients scheduled for elective cesarean section under spinal anesthesia were monitored for mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and concentrations of oxy-hemoglobin (Hb), deoxy-Hb, total-Hb, and tissue oxygenation index (TOI), before spinal anesthesia (baseline) and for 20 min after intrathecal injection of bupivacaine. We investigated changes in the values from baseline and evaluated whether the maximum changes in total-Hb (Δ-total-Hb) and TOI (Δ-TOI) correlate with changes in MAP at the same time point.

Results

The mean oxy-Hb, total-Hb, TOI, and MAP significantly decreased from baseline after intrathecal injection of bupivacaine (P < 0.01). There were significant positive correlations between both Δ-total-Hb and Δ-TOI and the decrease in MAP (Δ-total-Hb: r = 0.53, P < 0.01; Δ-TOI: r = 0.59, P < 0.01).

Conclusions

Maternal rCBV and rCBO decrease significantly during spinal anesthesia for cesarean section. Reductions in rCBV and rCBO may be associated with the severity of hypotension induced by subarachnoid sympathetic block with bupivacaine.
Literature
1.
Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesh Analg. 2012;114:377–90.CrossRef
2.
Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology. 1982;56:68–70.CrossRefPubMed
3.
Berlac PA, Rasmussen YH. Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia. Int J Obstet Anesth. 2005;14:26–31.CrossRefPubMed
4.
Kondo Y, Sakatani K, Hirose N, Maeda T, Kato J, Ogawa S, Katayama Y. Effect of spinal anesthesia for elective cesarean section on cerebral blood oxygenation changes: comparison of hyperbaric and isobaric bupivacaine. Adv Exp Med. 2013;765:109–14.CrossRef
5.
Sakatani K, Xie Y, Lichty W, Li S, Zuo H. Language-activated cerebral blood oxygenation and hemodynamic changes of the left prefrontal cortex in poststroke aphasic patients: a near-infrared spectroscopy study. Stroke. 1998;29:1299–304.CrossRefPubMed
6.
Demura S, Yamaji S, Kitabashi T, Yamada T, Uchiyama M. Effect of room temperature and body position change on cerebra blood volume and center-of-foot pressure in healthy young adults. J Physiol Anthropol. 2008;27:63–70.CrossRefPubMed
7.
Terborg C, Birkner T, Schack B, Weiller C, Röther J. Noninvasive monitoring of cerebral oxygenation during vasomotor reactivity tests by a new near-infrared spectroscopy device. Cerebrovasc Dis. 2003;16:36–41.CrossRefPubMed
8.
Kuroda S, Houkin K, Abe H, Hoshi Y, Tamura M. Near-infrared monitoring of cerebral oxygenation state during carotid endarterectomy. Surg Neurol. 1996;45:450–8.CrossRefPubMed
9.
Al-Rawi PG, Kirkpatrick PJ. Tissue oxygen index: thresholds for cerebral ischemia using near-infrared spectroscopy. Stroke. 2006;37:2720–5.CrossRefPubMed
10.
Tobias JD. Assessment of cerebral oxygenation using near infrared spectroscopy during isovolemic hemodilution in pediatric patients. J Clin Monit Comput. 2011;25:171–4.CrossRefPubMed
11.
Rout C, Rocke DA. Spinal hypotension associated with cesarean section: will preload ever work? Anesthesiology. 1990;91:1565–7.CrossRef
12.
Nishikawa K, Hagiwara R, Nakamura K, Ishizeki J, Kubo K, Saito S, Goto F. The effect of the extent of spinal block on the BIS score and regional cerebral oxygen saturation in elderly patients: a prospective, randomized, and double-blinded study. J Clin Monit Comput. 2007;21:109–14.CrossRefPubMed
13.
Minville V, Asehnoune K, Salau S, Bourdet B, Tissot B, Lubrano V, Fourcade O. The effect of spinal anesthesia on cerebral blood flow in the very elderly. Anesth Analg. 2009;108:1291–4.CrossRefPubMed
14.
Kawamoto M, Tanaka N, Takasaki M. Power spectral analysis of heart rate variability after spinal anesthesia. Br J Anaesth. 1993;71:523–7.CrossRefPubMed
15.
Deegan BM, Davine ER, Geraghty MC, Jones E, Ólaighin G, Serrador JM. The relationship between cardiac output and dynamic cerebral autoregulation in humans. J Appl Physiol. 2010;109:1424–31.CrossRefPubMedPubMedCentral
16.
Kaya S, Kolodjaschna J, Berisha F, Schmetterer L, Garhöfer G. Comparison of the autoregulatory mechanisms between central retinal artery and posterior ciliary arteries after thigh cuff deflation in healthy patients. Microvasc Res. 2011;82:269–73.CrossRefPubMed
17.
Karinen J, Räsänen J, Alahuhta S, Jouppila R, Jouppila P. Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section. Br J Anaesth. 1995;75:531–5.CrossRefPubMed
18.
Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg. 2009;108:1592–8.CrossRefPubMed
19.
Tihtonen K, Kööbi T, Yli-Hankala A, Uotila J. Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand. 2005;84:355–61.CrossRefPubMed
20.
Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, Greenwood J, James MF. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009;111:753–65.CrossRefPubMed
21.
Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg. 2010;111:1230–7.CrossRefPubMed
22.
Foss VT, Christensen R, Rokamp KZ, Nissen P, Secher NH, Nielsen HB. Effect of phenylephrine vs. ephedrine on frontal lobe oxygenation during caesarean section with spinal anesthesia: an open label randomized controlled trial. Front Physiol. 2014. doi:10.​3389/​fphys.​2014.​00081.PubMedPubMedCentral
23.
Nissen P, Brassard P, Jørgensen TB, Secher NH. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care. 2010;12:17–23.CrossRefPubMed
24.
Balki M, Carvalho JCA. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005;14:230–41.CrossRefPubMed
25.
Racke K, Schworer H. Regulation of serotonin release from the intestinal mucosa. Pharmacol Res. 1991;23:13–25.CrossRefPubMed
26.
Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia. Anesthesiology. 2003;98:530–47.CrossRefPubMed
27.
Davie SN, Grocott HP. Impact on extracranial contamination on regional cerebral oxygenation saturation. Anesthesiology. 2012;116:830–40.CrossRef
28.
Minati L, Kress IU, Visani E, Medford N, Critchley HD. Intra- and extra- cranial effects of transient blood pressure changes on brain near-infrared spectroscopy (NIRS) measurements. J Neourosci Methods. 2011;197:283–8.CrossRef
29.
Buunk G, van der Hoeven JG, Meinders AE. A comparison of near-infrared spectroscopy and jugular bulb oximetry in comatose patients resuscitated from a cardiac arrest. Anaesthesia. 1998;53:13–9.CrossRefPubMed
30.
Rostrup E, Law I, Pott F, Ide K, Knudsen GM. Cerebral hemodynamics measured with simultaneous PET and near-infrared spectroscopy in humans. Brain Res. 2002;954:183–93.CrossRefPubMed
31.
Schyzt HW, Wienecke T, Jensen LT, Selb J, Boas DA, Ashina M. Changes in cerebral blood flow after acetazolamide: an experimental study comparing near-infrared spectroscopy and SPECT. Eur J Neurol. 2009;16:461–7.CrossRef
Metadata
Title
Relationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section
Authors
Noriya Hirose
Yuko Kondo
Takeshi Maeda
Takahiro Suzuki
Atsuo Yoshino
Publication date
01-08-2016
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 4/2016
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-016-2165-6

Other articles of this Issue 4/2016

Journal of Anesthesia 4/2016 Go to the issue

Clinical Report

Effects of heparin bridging anticoagulation on perioperative bleeding and thromboembolic risks in patients undergoing abdominal malignancy surgery

Original Article

Effects of long-term infusion of sedatives on the cognitive function and expression level of RAGE in hippocampus of rats

Original Article

Ciproxifan, an H3 receptor antagonist, improves short-term recognition memory impaired by isoflurane anesthesia

Clinical Report

Use of the ETView Tracheoscopic Ventilation Tube in airway management of a patient with unanticipated difficult bag-mask ventilation

Letter to the Editor

Comparing face-to-face intubation with different devices

Editorial

Pharmacokinetics and systemic toxicity of local anesthetics in children