title: Epidural sufentanil does not attenuate the central haemodynamic effects of caesarean section performed under epidural anaesthesia.
abstract: The effect of sufentanil 30 micrograms added to the epidural local anaesthetic solutions used for anaesthesia during elective Caesarean section on central haemodynamic variables was studied. Haemodynamic measurements made by thoracic electrical bioimpedance (TEB) monitoring were compared in 21 healthy parturients undergoing Caesarean section under epidural anaesthesia with and without the addition of epidural sufentanil. The patients were randomized to control (Group C) and study (Group S) groups. Following iv prehydration, an epidural catheter was placed at the L2-3 or L3-4 interspace. After a negative test dose, in a double-blinded protocol, patients in Group S received sufentanil 30 micrograms (0.6 ml) in 4.4 ml lidocaine carbonate 2% with 5 micrograms.ml-1 epinephrine and those in Group C received 5 ml lidocaine carbonate 2% with epinephrine. Lidocaine carbonate 2% with 5 micrograms.ml-1 epinephrine was then titrated to establish an anaesthetic level of T4. Haemodynamic variables (heart rate, mean arterial blood pressure, cardiac index, ejection fraction and end-diastolic index) were measured non-invasively, continuously throughout the perioperative period. There were no differences noted in haemodynamic measurements between the groups at any time perioperatively. However, differences occurred within the groups when compared with baseline values. Heart rate was increased in both groups intraoperatively. Cardiac index was increased throughout the intraoperative period in Group S but was less frequently elevated in Group C. Ejection fraction was increased throughout the perioperative period in Group S but not in Group C. End-diastolic index increased following iv preloading in both groups and returned to baseline with induction of epidural block.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Anaesthesia, University of Ottawa, Ottawa General Hospital, Ontario.
authors.forename: E T
authors.initials: ET
authors.lastname: Crosby
authors.forename: G L
authors.initials: GL
authors.lastname: Bryson
authors.forename: R D
authors.initials: RD
authors.lastname: Elliott
authors.forename: C
authors.initials: C
authors.lastname: Gverzdys
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002307:Cardiography, Impedance; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D011247:Pregnancy; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D017409:Sufentanil / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D008012:Lidocaine; D017409:Sufentanil