title: Suprasternal Doppler estimation of cardiac output: standard versus sequential combined spinal epidural anesthesia for cesarean delivery.
abstract: BACKGROUND
  Sequential (Seq) combined spinal epidural (CSE) may provide better cardiovascular stability than standard (Std) CSE for cesarean delivery. We compared the cardiovascular stability of both techniques using suprasternal Doppler.
  
  
  METHODS
  Healthy women (n = 40) scheduled for elective cesarean delivery were randomized into two groups; Std or Seq CSE. Serial measures of cardiac output indices, including minute distance, stroke distance, stroke volume, peak velocity, and corrected flow time, were recorded before and after intravascular fluid administration and after CSE. Women received either hyperbaric bupivacaine 10 mg (Std) or 5 mg (Seq) with intrathecal fentanyl 15 microg. An epidural top-up with bupivacaine 0.5% w/v (5 mL at 20 min in the Std group and 10 mL at 15 min followed by 5 mL at 25 min in the Seq group) was given if predefined sensory targets were not met. Data were collected every 5 min after intrathecal injection. Hypotension was treated with ephedrine. Statistical analyses included repeated measures analysis of variance, analysis of covariance and Student's t-test. P < 0.05 denoted significance.
  
  
  RESULTS
  Results showed no difference in cardiac output, minute distance, stroke distance, stroke volume, peak velocity, or corrected flow time between groups over the first 20 min after spinal injection. For whole measurement periods, mean lowest values for these same measures showed no group differences.
  
  
  CONCLUSIONS
  We therefore found no benefit in terms of cardiovascular stability of Seq to Std CSE for elective cesarean delivery in the healthy pregnant population.
authors.affiliation: Department of Anesthetics, Royal Free Hospital, Pond Street, London, United Kingdom.
authors.forename: Johanna K
authors.initials: JK
authors.lastname: Bray
authors.forename: Roshan
authors.initials: R
authors.lastname: Fernando
authors.forename: Nisa P
authors.initials: NP
authors.lastname: Patel
authors.forename: Malachy O
authors.initials: MO
authors.lastname: Columb
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002302:Cardiac Output / Q000502:physiology*; D002585:Cesarean Section; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine