title: Epidural anesthesia worsens uterine blood flow and fetal oxygenation during hemorrhage in gravid ewes.
abstract: Recent studies suggest that epidural anesthesia initiated before hemorrhage may improve survival and acid-base status in laboratory animals. However, studies of hemorrhagic shock in nonpregnant animals may not be applicable to less severe hemorrhage in pregnant animals. The purpose of this study was to determine whether epidural anesthesia alters maternal and fetal hemodynamic and acid-base responses to hemorrhage in gravid ewes. Twenty-four experiments were performed in twelve chronically instrumented animals between 0.8 and 0.9 of timed gestation. The experimental sequence included: 1) T = 0 min: normal saline 500 ml intravenously; 2) T = 15 min: epidural administration of 0.5% bupivacaine (epidural group) or normal saline (control group); 3) T = 30 min: epidural administration of additional 0.5% bupivacaine (epidural group only) if the sensory level of anesthesia was below T10; 4) T = 45 min: maternal hemorrhage 20 ml/kg over 55 min; and 5) T = 110 min: transfusion of collected maternal blood over 55 min. At 45 min (i.e., 30 min after the epidural injection of bupivacaine), epidural bupivacaine resulted in a median sensory level of T9 in the epidural group. At that time, maternal mean arterial pressure was less (P less than 0.05) in the epidural group than in the control group (14 +/- 2% below baseline versus 4 +/- 1% above baseline, respectively). Maternal mean arterial pressure, heart rate, cardiac output, and uterine blood flow, and fetal PO2 and pH all were significantly less during hemorrhage (P less than 0.05) in the epidural group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anesthesia, University of Iowa College of Medicine, Iowa City 52242.
authors.forename: R D
authors.initials: RD
authors.lastname: Vincent
authors.forename: D H
authors.initials: DH
authors.lastname: Chestnut
authors.forename: S L
authors.initials: SL
authors.lastname: Sipes
authors.forename: C S
authors.initials: CS
authors.lastname: DeBruyn
authors.forename: P
authors.initials: P
authors.lastname: Chatterjee
authors.forename: C S
authors.initials: CS
authors.lastname: Thompson
mesh_terms: D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000818:Animals; D002045:Bupivacaine / Q000009:adverse effects*; D002245:Carbon Dioxide / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D005333:Fetus / Q000187:drug effects / Q000378:metabolism*; D006439:Hemodynamics / Q000187:drug effects; D006863:Hydrogen-Ion Concentration; D008012:Lidocaine / Q000009:adverse effects*; D010100:Oxygen / Q000378:metabolism; D011247:Pregnancy; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000378:metabolism*; D014592:Uterine Hemorrhage / Q000378:metabolism; D014599:Uterus / Q000098:blood supply*
chemical_list: D002245:Carbon Dioxide; D008012:Lidocaine; D010100:Oxygen; D002045:Bupivacaine; D004837:Epinephrine