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Published on: January 28, 2010
ST-segment depression and myocardial contractility during cesarean section under spinal anesthesia
1Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, PA 15044 USA.
Summary
ST-segment depression during Cesarean section indicates a hyperkinetic myocardial contractile state. This involves increased heart rate, cardiac index, and ejection fraction, with a decreased systolic time ratio.
Area of Science:
- Cardiology
- Anesthesiology
- Obstetrics
Background:
- Cesarean section (CS) is a common surgical procedure.
- Monitoring myocardial function during CS is crucial for patient safety.
- ST segment changes can indicate myocardial ischemia or altered contractility.
Purpose of the Study:
- To evaluate myocardial contractility in healthy parturients during Cesarean section (CS).
- To investigate the association between ST segment depression and myocardial performance metrics.
Main Methods:
- Studied 47 parturients undergoing elective CS under spinal anesthesia.
- Continuously recorded ST segment using Holter monitor (leads II and V5).
- Assessed myocardial performance via impedance cardiography (cardiac index, heart rate, pre-ejection period, ventricular ejection time, systolic time ratio, ejection fraction).
Main Results:
- 14 patients (30%) developed ST segment depression within 15 minutes post-delivery.
- During ST depression, heart rate, cardiac index, and ejection fraction increased significantly (P<0.01).
- Systolic time ratio decreased significantly (P=0.01) during ST depression compared to pre-anesthesia and control groups.
Conclusions:
- ST-segment depression during CS is linked to a hyperkinetic myocardial contractile state.
- These findings suggest a heightened myocardial response during this period.
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