title: [Optimization of the neuroautonomic inhibition and regulation of hemodynamics during subarachnoid anesthesia in abdominal delivery].
abstract: Pregnancy is considered in the spotlight of creation of general adaptation syndrome. It was revealed that 85% and 58% of healthy non-pregnant women had an inadequate autonomous nervous system (ANS) and circulatory system response respectively. This favoured the labour activity malfunction in 20% of women in childbirth when an abdominal delivery was needed. A traditional subarachnoid anesthesia (SA) in control group was accompanied by decrease of blood pressure (BP) to the numbers requiring a medicamentous correction (as by literature data). However, the central haemodynamics measures has shown a normal blood flow and the blood pressure correction was not performed. During surgery and in early post-operative period in all women in this group a parasympathetic tone has prevailed over, and the cardiac output was at the lower limit of the hypokinetic type of haemodynamics, which was accompanied with nausea and vomiting in 30% of women. Including the atropine administration into the traditional protocol of SA in cesarean section in pregnant patients with eu- and parasympathotonia (research group) has favoured the optimization of the neurovegetative inhibition of reflexes and stabilization of haemodynamics within the physiological ranges. Vagosympathetic block has been accompanied by sympathotonia with a lesser BP decrease compared to control group, absence of bradycardia, nausea and vomiting. Thus the BP can not serve as a criterion of the perfusion of essential organs, including uteroplacental haemodynamics, especially non-invasibe BP. Including the control of ANS tone dynamics, central haemodynamics and oxygen transport into monitoring guidelines in neuroaxial anaesthesia in abdominal delivery is necessary.
authors.forename: V A
authors.initials: VA
authors.lastname: Gur'ianov
authors.forename: G N
authors.initials: GN
authors.lastname: Tolmachev
authors.forename: A V
authors.initials: AV
authors.lastname: Volodin
authors.forename: N V
authors.initials: NV
authors.lastname: Marichik
authors.forename: V B
authors.initials: VB
authors.lastname: Nemirovskiĭ
mesh_terms: D000222:Adaptation, Physiological / Q000187:drug effects; D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local; D001034:Apgar Score; D001285:Atropine / Q000627:therapeutic use; D001341:Autonomic Nervous System / Q000187:drug effects / Q000503:physiopathology*; D002045:Bupivacaine; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative / Q000379:methods; D010952:Plasma Substitutes / Q000008:administration & dosage; D011247:Pregnancy; D013346:Subarachnoid Space
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D001285:Atropine; D002045:Bupivacaine