Impact of abdominal pressure on the course of spinal anesthesia in pregnant during Caesarean section
Introduction. The increase in intra-abdominal pressure (IAP) reduces the cerebrospinal fluid volume in the lumbar and lower-thoracic spinal canal, which may contribute to the development of higher level of spinal block. Currently, there are no studies on the effect of intra-abdominal pressure in pregnant on the development of spinal blockade. Aim: to study the effect of intra-abdominal pressure on spinal block level in pregnant, and the incidence of hypotension during cesarean section. Material and methods. Randomized, blinded, controlled study included 170 pregnant women with gestational age 38-40 weeks by elective cesarean section under spinal anesthesia. Pregnant were divided into two groups of 85 women each. In group 1, the anesthesiologist did not know the value of IAP and used the dose of local anesthetic, focusing on the pregnant height, weight, and his personal experience. In the second group an anesthesiologist corrected dose of local anesthetic depending on the IAP (at above 16 mm Hg the dose was reduced by 15-20% and 1-3 mg in direct proportion to the degree of intra-abdominal hypertension) also considered the height and weight of a pregnant. Results. The physiological normal level of IAP (≤12 mm Hg) had only 9,2% of pregnant women, 49% was recorded Grade I abdominal hypertension (12-15 mm Hg), at 40,3% - II degree (16-20 mm Hg), at 1,5% - III degree of intra-abdominal hypertension (21-25 mm Hg). In the first group the incidence of high spinal block (above Th 4) and hypotension (systolic blood pressure <90 mm Hg) was two times higher than in the second group (р <0, 01). Conclusions. Intra-abdominal hypertension in pregnant women contributed to the development of high spinal block and hypotension. The authors recommend a reduced dose of local anesthetic to prevent these complications using a Scale of the Risk of developing high spinal block in pregnant.