Effects Of Anesthesia Method On Hemodynamics During Cesarean Section And Postoperative Outcomes In Pregnancy With Pulmonary Hypertension

Purpose To explore the effects of anesthesia method on intraoperative hemodynamics and postoperative outcomes of cesarean section in pregnant women with pulmonary hypertension.Methods A retrospective review was carried out of pregnant women complicated with pulmonary hypertension who underwent cesarean section in Nanjing Drum Tower Hospital from January 1,2011 to December 31,2017.According to inclusion and exclusion criteria,there were 116 patients enrolled eventually.The patients were divided into three groups according to their anesthesia method: general anesthesia group(general group),spinal anesthesia group(spinal group)and other anesthesia group(other group),including epidural anesthesia and combined spinal-epidural anesthesia.The preoperative clinical data,the values of hemodynamic parameters and their variation at the specific time of cesarean section,and maternal/neonatal outcomes were collected and compared.The risk factors affecting the maternal and neonatal postoperative ICU/NICU occupancy rate were also analyzed.Results (1)The variations of blood oxygen saturation in spinal group were significantly less than those of the other two groups during the fetal delivery,the lowest point after fetal delivery,and the end of anesthesia(P<0.05).Except that,there were no significant differences between three groups in intraoperative hemodynamic variations.The total intraoperative infusion volume in the spinal group was significantly higher than that in the other two groups(P<0.05).There was no significant difference in total intraoperative output volume and liquid balance between the three groups(P>0.05).The use of vasoactive drugs in general group was significantly higher than that in the spinal group and other groups(P<0.05).(2)In a total of 85 cases,the maternal mortality was 2.4%(2/85).The maternal mortality in general group,spinal group and other group were respectively 9.1%(1/11),1.5%(1/66)and 0%(0/8),which had a statistical differences(P<0.05).The maternal ICU occupancy rate,the duration of ICU occupancy,the rate of postoperative mechanical ventilation,and the maternal postoperative complication rate in the spinal group were all lower than those in the other two groups(P<0.05).(3)In a total of 82 cases,the neonatal mortality was 2.4%(2/82).The maternal mortality in spinal group(0%,0/65)was significantly lower than that in general group(11.1%,1/9)and other group(12.5%,1/8).The number of preterm delivery,neonatal asphyxia,low birth weight,neonatal NICU occupancy rate and the duration of NICU occupancy among three groups were statistically different,which were all lowest in spinal group.The 1/5 min Apgar score and neonatal birth weight in spinal group were significantly higher than those in the other two groups(P<0.05).(4)Severe pulmonary hypertension(OR=11.639),ASA>2(OR=4.405)and intraoperative vasoactive drugs(OR=4.468)were independent risk factors for the maternal postoperative ICU admission.Spinal anesthesia(OR=0.091)is a protective factor;Preterm delivery(OR=5.356)and low birth weight(OR=22.583)are independent risk factors for the neonatal NICU admission.Conclusions In this study,general anesthesia and intraspinal anesthesia make similar contribution to stabilize intraoperative hemodynamics,however the use of vasoactive drugs during cesarean section is higher in general anesthesia;Pregnant women who received spinal anesthesia have the most excellent postoperative maternal and neonatal outcomes;Severe pulmonary hypertension,ASA>2,intraoperative vasoactive drugs will increase the risk of maternal ICU admission after cesarean section,the use of spinal anesthesia can reduce the risk.Premature delivery,low birth weight will increase the risk of neonatal NICU admission.Therefore,it is recommended that spinal anesthesia should be the first choice in cesarean section of women undergoing pulmonary hypertension.