Maternal Haemodynamic Changes during Caesarean Section: A Comparison of Epidural and General Anaesthesia

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Abstract
Hemodynamic measurements were performed on 20 healthy women before and during elective caesarean section under epidural (10 women) or general anaesthesia (10 women). The influence of the 2 anesthetic techniques on the hemodynamic changes associated with operative delivery was compared. The following hemodynamic variables were studied: cardiac output (CO), stroke volume (SV) determined non-invasively with impedance cardiography, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), pulse pressure, mean arterial pressure (MAP) and total peripheral vascular resistance (TRP). During epidural anesthesia, SV was largely unchanged before delivery but increased (P < 0.05) following delivery. CO increased (P < 0.05) prior to delivery due to an increase (P < 0.01) in HR. A further increase (P < 0.05) in CO was recorded following delivery. SBP, DBP, MAP and TRP decreased (P < 0.05) during epidural anesthesia. In the patients undergoing general anesthesia, SV decreased (P < 0.05) prior to delivery. CO remained largely unchanged due to an increase (P < 0.01) in HR. Following delivery, CO (P < 0.05) and SV (P < 0.01) increased whereas HR decreased (P < 0.01). SBP, DBP and MAP increased (P < 0.01) prior to delivery, returning to the same level as prior to induction of anesthesia following delivery. TPR was largely unchanged prior to delivery but decreased (P < 0.01) following delivery.

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