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This is a study of pregnant women undergoing a cesarean delivery. It will compare their microcirculation before and after the anesthetic. Microcirculation means blood flow to the extremely small blood vessels in the body. It will also look at the differences in microcirculation of participants who receive an infusion of phenylephrine compared to participants who don't. The investigators hypothesize that spinal anesthesia will reduce the vascular density and proportion of perfused vessels.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Bolus Phenylephrine/Ephedrine Treatment' | Experimental | Initial MicroScan® (Microvision Medical) SDF measurement are recorded in the obstetric preoperative area within two hours prior to administration of spinal anesthesia. In the operating room participants will receive a standard spinal anesthetic (hyperbaric bupivacaine, fentanyl and preservative free morphine) followed by a second comparative MicroScan® (Microvision Medical) SDF measurement within 10 minutes of initiation of spinal anesthetic. Participants who experience hypotension will receive bolus phenylephrine and/or ephedrine treatment as needed. |
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| Phenylephrine Infusion Group | Experimental | Initial MicroScan® (Microvision Medical) SDF measurement are recorded in the obstetric preoperative area within two hours prior to administration of spinal anesthesia. In the operating room participants will receive a standard spinal anesthetic (hyperbaric bupivacaine, fentanyl and preservative free morphine) followed by a second comparative MicroScan® (Microvision Medical) SDF measurement within 10 minutes of initiation of spinal anesthetic. Participants will have an infusion of phenylephrine started immediately following the induction of spinal anesthesia for prevention of hypotension. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Initial MicroScan® (Microvision Medical) SDF Measurement | Device | Initial SDF measurements are recorded in the obstetric preoperative area within two hours prior to administration of spinal anesthesia. |
| Measure | Description | Time Frame |
|---|---|---|
| Microvascular Flow Index (MFI) | The change in MFI of participants; measured immediately prior to, and within 10 minutes following the induction of spinal anesthesia | Immediately prior to, and within 10 minutes of induction of spinal anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Microvascular Flow Index (MFI) | The difference between the MFI measured within 10 minutes following the induction of spinal anesthesia in participants who receive phenylephrine via a continuous infusion for the prevention of spinal anesthesia-induced hypotension compared to those who may receive phenylephrine boluses for treatment of spinal anesthesia-induced hypotension. | Immediately prior to, and within 10 minutes of induction of spinal anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Total Vessel Density (TVD) | Immediately prior to, and within 10 minutes of induction of spinal anesthesia | |
| Perfused Vessel Density (PVD) | Immediately prior to, and within 10 minutes of induction of spinal anesthesia |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ronald B George, MD FRCPC | IWK Health Centre, Dalhousie University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| IWK Health Centre | Halifax | Nova Scotia | B3K 6R8 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24934438 | Background | George RB, DesRoches J, Abdo I, Lehmann C. Maternal microcirculation and sidestream dark field imaging: a prospective assessment of the association between labour pain and analgesia on the microcirculation of pregnant women. Clin Hemorheol Microcirc. 2015;60(4):389-95. doi: 10.3233/CH-141851. | |
| 24702490 | Background |
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| Spinal Anesthesia- Bupivacaine | Drug | The spinal anesthetic technique is standardized. In the operating room spinal anesthesia will be administered with the L2-L5 interspaces in the sitting position using 12 mg of hyperbaric bupivacaine with 15 mcg of fentanyl and 150 mcg of preservative free morphine. |
|
| Comparative MicroScan® (Microvision Medical) SDF Measurement | Device | A second comparative SDF measurement be recorded within 10 minutes after induction of spinal anesthesia. |
|
| Bolus Phenylephrine/Ephedrine Treatment | Drug | Participants who experience hypotension following induction of spinal anesthesia will be treated with a bolus of phenylephrine and/or ephedrine as needed. |
|
| Phenylephrine Infusion | Drug | Participants will have an infusion of phenylephrine started immediately following the induction of spinal anesthesia for prevention of hypotension. |
|
| Proportion of perfused vessels (PPV) | Immediately prior to, and within 10 minutes of induction of spinal anesthesia |
| Abdo I, George RB, Farrag M, Cerny V, Lehmann C. Microcirculation in pregnancy. Physiol Res. 2014;63(4):395-408. doi: 10.33549/physiolres.932511. Epub 2014 Apr 3. |
| 24342223 | Background | George RB, Munro A, Abdo I, McKeen DM, Lehmann C. An observational assessment of the sublingual microcirculation of pregnant and non-pregnant women. Int J Obstet Anesth. 2014 Feb;23(1):23-8. doi: 10.1016/j.ijoa.2013.08.013. Epub 2013 Sep 8. |
| 24448730 | Background | Lehmann Ch, Abdo I, Kern H, Maddison L, Pavlovic D, Sharawi N, Starkopf J, Hall R, Johnson P, Williams L, Cerny V; MiDAS (Microcirculation Diagnostics and Applied Studies) group. Clinical evaluation of the intestinal microcirculation using sidestream dark field imaging--recommendations of a round table meeting. Clin Hemorheol Microcirc. 2014;57(2):137-46. doi: 10.3233/CH-141810. |