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Cardiac output will be measured in healthy parturients undergoing cesarean delivery under spinal anesthesia
ASA-II women undergoing cesarean delivery under spinal anesthesia will be included. Cardiac output will be measured using transthoracic echocardiography at 4 time points: Baseline, after 10 minutes of intrathecal injection, after delivery, and after 1 hour of intrathecal injection. Spinal anesthesia will be administered with 2.5 ml bupivacaine 0.5% and fentanyl 15 μg.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study Group | Cardiac output will be measured at baseline using transthoracic echocardiography. Spinal anesthesia will be administered with injection of intrathecal bupivacaine and intrathecal fentanyl. Crystalloid coload 1000 mL will be administered: Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection. Cardiac output will be measured at 10 minutes after intrathecal injection, immediately after delivery, at 1 hour after intrathecal injection. Cesarean delivery will be performed. Intravenous ephedrine will be administered to correct hypotension. After delivery, 10 units of oxytocin in 500 ml Ringer acetate will be administered over 30 minutes. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Transthoracic Echocardiography | Radiation | Measurement of cardiac output in supine position with left lateral tilt at baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in cardiac output | Cardiac output measured using transthoracic echocardiography | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in stroke volume | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection | |
| Changes in heart rate | At baseline, at 10 minutes after intrathecal injection, immediately after delivery, and at 1 hour after intrathecal injection |
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Inclusion Criteria:
Exclusion Criteria:
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Healthy women with full term, singleton pregnancy presenting for elective cesarean delivery under spinal anesthesia in a tertiary obstetric hospital
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| Name | Affiliation | Role |
|---|---|---|
| Mohamed M Tawfik, MD | Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals | Al Mansurah | Dakahlia Governorate | 35516 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40795509 | Derived | Tawfik MM, Hafez SM, Abdelmohaymen HA, Ismail OM. Serial echocardiographic measurements of cardiac output after spinal anesthesia for scheduled cesarean delivery in healthy patients: a prospective observational study. Int J Obstet Anesth. 2025 Nov;64:104752. doi: 10.1016/j.ijoa.2025.104752. Epub 2025 Aug 8. |
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| Spinal Anesthesia | Procedure | Performed at the L3-L4 or L4-L5 interspace using 25-gauge spinal needle |
|
| Intrathecal Bupivacaine | Drug | Bupivacaine 12.5 mg (2.5 mL 0.5%) will be administered in the subarachnoid space |
|
| Intrathecal Fentanyl | Drug | Fentanyl 15 μg will be administered in the subarachnoid space |
|
| Crystalloid Coload 1000 mL | Drug | Ringer acetate 1000 mL will be administered over 10 minutes starting immediately after intrathecal injection |
|
| Cesarean Delivery | Procedure | Lower segment cesarean section using the Pfannenstiel incision and uterine exteriorization |
|
| Intravenous Ephedrine | Drug | Intravenous ephedrine 3, 5, and 10 mg will be administered when Systolic blood pressure decreases below 90%, 80%, and 70% of baseline, respectively. |
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| Oxytocin | Drug | Intravenous oxytocin 10 U in 500 mL Ringer acetate will be administered over 30 minutes starting immediately after delivery of the fetus |
|
| Number of subjects requiring ephedrine | From intrathecal injection to the end of cesarean delivery |
| Incidence of hypotension | Systolic blood pressure <80% of baseline | From intrathecal injection to the end of cesarean delivery |
| Incidence of severe hypotension | Systolic blood pressure <70% of baseline | From intrathecal injection to the end of cesarean delivery |
| Incidence of bradycardia | Heart rate <50 beats/min | From intrathecal injection to the end of cesarean delivery |
| Incidence of nausea and/or vomiting | From intrathecal injection to the end of cesarean delivery |
| Neonatal Apgar scores | At 1 and 5 minutes after delivery |
| ID | Term |
|---|---|
| D000775 | Anesthesia, Spinal |
| D002585 | Cesarean Section |
| D010121 | Oxytocin |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D036861 | Delivery, Obstetric |
| D013513 | Obstetric Surgical Procedures |
| D013514 | Surgical Procedures, Operative |
| D010909 | Pituitary Hormones, Posterior |
| D010907 | Pituitary Hormones |
| D036361 | Peptide Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
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