Incremental spinal anaesthesia for elective caesarean section: maternal and fetal haemodynamic effects

We have performed serial haemodynamic investigations in 20 women undergoing elective Caesarean section under continuous spinal anaesthesia with a 32-gauge catheter with 0.5% heavy bupivacaine. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. Doppler flow velocity waveforms were recorded also from the umbilical artery. A block to T4 or above was achieved in all patients. The median dose of 0.5% bupivacaine administered was 2.0 ml (range 1.5-4.5 ml). Mean cardiac output increased from 7 to 8 litre min-1 after preloading with Ringer lactate solution 1.5 litre and then remained unchanged after injection of bupivacaine. Two subjects developed hypotension, although mean values of arterial pressure and umbilical artery pulsatility index did not change. The median umbilical artery pH was 7.27 (range 6.98-7.32) and there was a significant correlation between pH and the maximum percentage decrease in cardiac output. The results suggest that continuous spinal anaesthesia is associated with greater haemodynamic stability than single bolus spinal injection.