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Transient maternal hypotension following epidural anesthesia
E H Philipson1, B R Kuhnert, R Pimentel
1Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland Metropolitan General Hospital, Ohio 44109.
Anesthesia and Analgesia
|November 1, 1989
Summary
Transient maternal hypotension after epidural anesthesia can lower umbilical cord pH. However, this does not increase placental transfer of bupivacaine due to ion trapping, despite the acidosis.
Area of Science:
- Anesthesiology
- Neonatal Physiology
- Pharmacology
Background:
- Transient maternal hypotension following regional anesthesia can decrease umbilical cord pH.
- Acidosis may enhance placental transfer of local anesthetics via "ion trapping."
Purpose of the Study:
- To investigate the pharmacologic and clinical effects of transient maternal hypotension after epidural anesthesia with bupivacaine during cesarean section.
Main Methods:
- Patients undergoing cesarean section with epidural anesthesia were divided into two groups: those who developed hypotension and those who did not.
- Maternal hypotension was defined as systolic blood pressure < 100 torr or a ≥30% decrease from preanesthetic levels.
Main Results:
- 13% of patients experienced transient hypotension, corrected within approximately 2 minutes.
- Neonates born to mothers experiencing hypotension had significantly lower umbilical cord venous and arterial blood pH and bupivacaine concentrations.
- Despite decreased neonatal cord blood pH, maternal hypotension did not result in increased placental transfer of bupivacaine via "ion trapping."
Conclusions:
- Transient maternal hypotension following epidural anesthesia does not lead to increased placental transfer of bupivacaine through "ion trapping."
- The observed decrease in neonatal cord blood pH is not clinically significant in the context of transient hypotension.