Medical doctoral thesis summary: Study on the hemodynamic efects of phenylephrine in the management of hypotension during spinal anesthesia for cesarean section

This topic is conducted with the two following objectives: Compare the effects of phenylephrine with ephedrine on hemodynamic measured by the non-invasive method Niccomo in the management of the hypotension during SA for cesarean section; to evaluate some undesirable effects of phenylephrine and ephedrine on mother and newborn during SA for cesarean section.
Nội dung trích xuất từ tài liệu:
Medical doctoral thesis summary: Study on the hemodynamic efects of phenylephrine in the management of hypotension during spinal anesthesia for cesarean section MINISTRY OF MINISTRY OF HEALTH EDUCATION AND TRAINING HANOI MEDICAL UNIVERSITY STUDY ON THE HEMODYNAMIC EFECTS OF PHENYLEPHRINE IN THE MANAGEMENT OF HYPOTENSION DURING SPINAL ANESTHESIA FOR CESAREAN SECTION Specialized in : Anesthesiology Code : 62 72 01 21 MEDICAL DOCTORAL THESIS SUMMARY HA NOI - 2019 WORKS ARE COMPLETED AT HANOI MEDICAL UNIVERSITY Science instructor: Professor NGUYEN Quoc Kinh The thesis will be presented in School thesis council At … h00, day ……. month …..year 2019 The thesis can be found at: - National library - Library of Hanoi Medical University ABBREVIATIONS BMI : Body Mask Index CO : Cardiac Output CI : Cardiac Index ECG : Electrocardiogram GTTS : Spinal anesthesia – SA HA : Blood pressure – BP HATT : Systolic arterial blood pressure – SBP – SAP HATTr : Diastolic arterial blood pressure – DBP, DAP HATB : Mean blood pressure – MAP HR : Heart Rate ICG : Impedance Cardiogram NMC : Epidural anesthesia Niccomo : Non Invasive Continuous Cardiac Output Monitoring SpO2 : Saturation of oxygenation SV : Stroke Volume SVV : Stroke Volume Veriation SVR : Systemic Vascular Resistance 1 INTRODUCTIONS Anesthesia in obstetrics for cesarean section increased due to the increasing the rate of cesarean section, which is a great concern of the anesthesiology because of the achievement of analgesic effect, good muscle relaxation to maximum facilitate the operation, ensuring safety for both mother and infant. Spinal anesthesia is preferred to anesthesia, is the first choice for cesarean section, hypotension when the Spinal anesthesia accounts for as high as 70% -80%. It is the most dangerous complication, causing bad consequences for mothers and children. Therefore, the problem of managing hypotension is always concerned and studied. The mechanism of hypotension in the spinal anesthesia (SA) is due to blockade of the sympathetic ganglion, leading to dilatation of the arterial system (resistance system), which reduces SVR and veinous dilatation (storage system) reduces venous return in a reduction of the preload and a decrease CO. The blood pressurs (BP) is directly proportional to CO and SVR. Thus hypotension can be due to decreased SVR and / or decreased CO. But reducing SVR also reduces afterload so it can improve CO. There have been studies on infusions around the world (comparing preload with coload, crystalloid and colloid fluids). Compare phenylephrine effect with ephedrine on the mother and children. At present, there are no or less invasive hemodynamic monitoring methods such as CNAP, Clearsight, Niccomo, USCOM… So in the world there are only a few studies on hemodynamic changes in SA. There have been no studies to assess the hemodynamic changes of pregnant women, umbilical cord blood gas in during the cesarean, of phenylephrine and ephedrine in particular when used to treat hypotension. Therefore, this topic is conducted with the two following objectives: 1. Compare the effects of phenylephrine with ephedrine on hemodynamic measured by the non-invasive method Niccomo in the management of the hypotension during SA for cesarean section. 2. To evaluate some undesirable effects of phenylephrine and ephedrine on mother and newborn during SA for cesarean section. *New contributions of the thesis: 1. Scientific and practical meanings: - The research is very necessary, to be new, especially when applying noninvasive hemodynamic monitoring method (Niccomo monitoring), the thesis has scientific and 2 practical significance. Proper, scientific and logical research design; The datas and the datas processing are reliable, the number of patients are large enough. - Ever, the main drug used is ephedrine to treat hypotension in the spinal anesthesia. However, the ephedrin is suspected of causing fetal acidosis in recent years. Therefore, foreign and domestic authors have come to phenylephrine to replace ephedrin. - The authors only researched and used the phenylephrine to increase blood pressure. No authors studied hemodynamic changes (BP, CO, SV, SVR, HR) by phenylephrine. This is the new point, the contribution of the topic to clinical practice and science. 2. The thesis has scientific significance, is up to date and very valuable in clinical gynaeco-obstertrical anesthesia: - The thesis compares the efficacy of the new vasoconstrictor that is phenylephrine versus the previously used vasoconstrictor, ephedrine, both of which are infused continuously to prevent the hypotension in the spinal anesthesia for cesarean section. - This study used a new hemodynamic monitoring method that is Niccomo system to continuously monitor hemodynamic indicators: heart rate, arterial blood pressure, cardiac output, stroke volume and the systemic vascular resistance. This hemodynamic monitoring method helps to accurately assess the effectiveness of the two vasoconstrictor drugs above and helps to guide the fluid infusion to manage hypotension during spinal anesthesia for cesarean section. *Layout of the thesis: The thesis consists of 113 pages (excluding references and appendices) of which: Introduction: 02 pages; Chapter 1 - Overview: 32 pages; Chapter 2 - Objects and Methods: 16 pages; Chapter 3 - Results: 27 pages; Chapter 4 - Discussion: 34 pages; Conclusion: 2 pages. The thesis has 38 ...