Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000100003
Brazilian Journal of Anesthesiology
Scientific Article

Correlação entre o índice de massa corporal (IMC) de gestantes e hipotensão após raquianestesia para cesarianas

Correlation between the body mass index (BMI) of pregnant women and the development of hypotension after spinal anesthesia for cesarean section

Fernando Souza Nani; Marcelo Luis Abramides Torres

http://dx.doi.org/10.1590/S0034-70942011000100003 Braz J Anesthesiol, vol.61, n1, p.25-30, 2011
PDF Português
PDF English
Downloads: 0
Views: 1039

Resumo

JUSTIFICATIVA E OBJETIVOS: Existem poucas publicações correlacionando hipotensão em gestantes obesas, principalmente em obesas mórbidas, após raquianestesia para cesárea. Objetivamos avaliar a incidência de hipotensão correlacionada ao IMC. MÉTODO: No grupo Eutrofia foram incluídas 49 pacientes com IMC pré-gestacional abaixo de 25 kg.m-2 e no grupo Sobrepeso, 51 pacientes com IMC igual ou acima de 25 kg.m-2. Após raquianestesia, foram anotadas as medidas de pressão arterial, volume de cristaloides infundidos e dose de vasopressores utilizada até o nascimento. Redução da pressão arterial sistólica abaixo de 100 mmHg ou 10% da pressão arterial sistólica (PAS) inicial foi classificada como hipotensão e corrigida com vasopressor. RESULTADOS: Os episódios de hipotensão foram menores no grupo Eutrofia (5,89 ± 0,53 vs. 7,80 ± 0,66; p = 0,027), assim como a quantidade de cristaloides (1.298 ± 413,6 mL vs. 1.539 ± 460,0 mL; p = 0,007) e o uso de vasopressores (5,87 ± 3,45 bolus vs. 7,70 ± 4,46 bolus; p = 0,023). Quanto às doenças associadas, observamos maior incidência de diabetes entre as gestantes obesas (29,41% vs. 9,76%, RR 1,60; IC 95%: 1,15-2,22; p = 0,036), porém não houve diferença entre os grupos em relação à incidência de doença hipertensiva específica da gestação (DHEG) (sobrepeso: 21,57%, peso normal: 12,20%, RR 1,30; IC 95%: 0,88-1,94; p = 0,28). CONCLUSÕES: Na amostra estudada, IMC pré-gestacional maior ou igual a 25 kg.m-2 apresentou-se como fator de risco para hipotensão após raquianestesia em pacientes submetidas a cesáreas. O mesmo grupo de pacientes necessitou de um número de doses maior de vasopressores. A valorização desses achados implica aprimorar as técnicas anestésicas nessas pacientes a fim de diminuir as consequências da hipotensão pós-raquianestesia, tanto na gestante como no feto.

Palavras-chave

CIRURGIA, Obstétrica, COMPLICAÇÕES, Hipotensão arterial, DOENÇA, Obesidade, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Very few publications correlate hypotension in obese pregnant women, and especially morbidly obese, after spinal anesthesia for cesarean section. The objective of the present study was to evaluate the incidence of hypotension according to the BMI. METHODS: Forty-nine patients with pregestational BMI below 25 kg.m-2 were included in the Eutrophia group, and 51 patients with BMI > 25 kg.m-2 were included in the Overweight group. After spinal anesthesia, blood pressure, volume of crystalloid infused, and dose of vasopressors used until delivery were recorded. A fall in systolic blood pressure below 100 mmHg or 10% reduction of the initial systolic blood pressure (SBP) was considered as hypotension and it was corrected by the administration of vasopressors. RESULTS: Episodes of hypotension were fewer in the Eutrophia group (5.89 ± 0.53 vs. 7.80 ± 0.66, p = 0.027), as well as the amount of crystalloid administered (1,298 ± 413.6 mL vs. 1,539 ± 460.0 mL; p = 0.007), and use of vasopressors (5.87 ± 3.45 bolus vs. 7.70 ± 4.46 bolus; p = 0.023). As for associated diseases, we observed higher incidence of diabetes among obese pregnant women (29.41% vs. 9.76%, RR 1.60, 95%CI: 1.15-2.22, p = 0.036), however, differences in the incidence of pregnancy-induced hypertension (PIH) were not observe between both groups (overweight: 21.57%, normal weight: 12.20%, RR 1.30, 95%CI: 0.88-1.94, p = 0.28). CONCLUSIONS: In the study sample, pregestational BMI > 25 kg.m-2 was a risk factor for hypotension after spinal anesthesia in patients undergoing cesarean section. The same group of patients required higher doses of vasopressors. Those results indicate that the anesthetic techniques in those patients should be improved to reduce the consequences of post-spinal anesthesia hypotension, both in pregnant women and fetuses.

Keywords

Obesity, Obesity, Morbid, Cesarean Section, Anesthesia, Obstetrical, Anesthesia, Spinal

References

Saravanakumar K, Rao SG, Cooper GM. Obesity and obstetric anaesthesia. Anaesthesia. 2006;61:36-48.

Braveman FR, Scavone BM, Wong CA. Obstetric Anesthesia. Clinical Anesthesia. 2009:1137-1170.

Cardoso MMSC, Yamaguchi ET, Khouri Filho RA. Analgesia para Trabalho de Parto. Tratado de Anestesiologia: SAESP. 2006:1783-1790.

von Ungern-Sternberg BS, Regli A, Bucher E. Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section. Anaesthesia. 2004;59:743-749.

Carpenter RL, Caplan RA, Brown DL. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-916.

Hartmann B, Junger A, Klasen J. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002;94:1521-1529.

Tarkkila P, Isola J. A regression model for identifying patients at high risk of hypotension, bradycardia and nausea during spinal anesthesia. Acta Anaesthesiol Scand. 1992;36:554-558.

Roofthooft E, Van de Velde M. Low-dose spinal anaesthesia for Caesarean section to prevent spinal-induced hypotension. Curr Opin Anaesthesiol. 2008;21:259-262.

Cardoso MMSC, Hirahara JT. Anestesia para Operação Cesariana. Tratado de Anestesiologia: SAESP. 2006:1791-1804.

Morgan Jr GE, Mikhail MS, Murray MJ. Obstetric Anesthesia. Clinical Anesthesiology. 2006:890-906.

Bamgbade OA, Khalaf WM, Ajai O. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study. Int J Obstet Anesth. 2009;18:221-225.

Obesity: preventing and managing the global epidemic. Report of a WHO consultation. 2000:1-253.

Nucci LB, Schmidt MI, Duncan BB. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica. 2001;35:502-507.

Chang AB. Physiologic Changes of Pregnancy. Obstetric Anesthesia: Principles and Practice. 2004:15-36.

Roofthooft E. Anesthesia for the morbidly obese parturient. Curr Opin Anaesthesiol. 2009;22:341-346.

Veille JC, Hanson R. Obesity, pregnancy, and left ventricular functioning during the third trimester. Am J Obstet Gynecol. 1994;171:980-983.

Vallejo MC. Anesthetic management of the morbidly obese parturient. Curr Opin Anaesthesiol. 2007;20:175-180.

Tomoda S, Tamura T, Sudo Y. Effects of obesity on pregnant women: maternal hemodynamic change. Am J Perinatol. 1996;13:73-78.

Pian-Smith MCM, Datta S, Greene MF. The Diabetic Parturient. Anesthetic and Obstetric of High-Risk Pregnancy. 2004:333-346.

Cohn AI, Hart RT, McGraw SR. The Bullard laryngoscope for emergency airway management in a morbidly obese parturient. Anesth Analg. 1995;81:872-873.

Sharwood-Smith G, Drummond GB. Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia. Br J Anaesth. 2009;102:291-294.

Soens MA, Birnbach DJ, Ranasinghe JS. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand. 2008;52:6-19.

5dd6d6a40e8825b40413f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections