Electrocardiographic Changes in Elective Cesarean Delivery after Oxytocin Injection: Regional Anesthesia versus General Anesthesia

  • Gita Shoeibi From the 1Department of Anesthesiology and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Hamid Hoseini From the 1Department of Anesthesiology and Critical Care, ShariatiHospital, Tehran University of Medical Sciences,Tehran,Iran.
  • Shaqayeq Marashi From the 1Department of Anesthesiology and Critical Care, ShariatiHospital, Tehran University of MedicalSciences, Tehran,Iran.
  • Amir Abbas Yaghooti Department of Anesthesiology and Critical Care, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Mozhde Jalali Department of Anesthesiology and Critical Care, Tehran UniversityofMedicalSciences, Tehran, Iran.
  • Abbas Ostad Alipour Department of Anesthesiology and Critical Care, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: electrocardiography, cesarean section, oxytocin, myocardial ischemia, general anesthesia, spinal anesthesia

Abstract

Background: There is evidence that electrocardiographic (ECG) changes occur during elective cesarean section in parturients. These changes, mostly in the form of ST-segment depression, have been noted in either regional anesthesia or general anesthesia. We performed this study to compare hemodynamic variables and electrocardiographic changes suggestive of myocardial ischemia following administration of oxytocin in elective cesarean delivery between regional and general anesthesia methods.Methods: In this double-blinded randomized clinical trial, 130 parturients were randomly divided into two groups of general anesthesia (65 cases) and spinal anesthesia (65 cases). After delivery of the baby and placenta, firstly a bolus of 5 units of oxytocin was injected, and then 30 units of oxytocin was infused over 30 minutes in both groups. Hemodynamic variables including heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were studied. ECG recording was done twice (1 hour and 24 hour) after the operation. For those who demonstrated ECG changes, serum troponin I level was measured.Results: The ECG changes suggestive of ischemia was higher in general anesthesia group (36.9%, 24 cases) compared to spinal anesthesia group (24.6%, 16 cases), but it was not statistically significant (P= 0.12). Troponin I levels checked for patients with ECG changes were all within normal limits.Conclusion: Although ST depression on ECG was more prevalent in parturients who underwent cesarean section under general anesthesia compared to spinal anesthesia, the difference was not statistically significant. None of the cases demonstrated myocardial injury based on Troponin I measurements.

References

Mathew JP, Fleisher LA, Rinehouse JA, Sevarino FB, Sinatra RS, Nelson AH, et al. ST segment depression during labor and delivery. Anesthesiology. 1992; 77(4):635-41.

McLintic AJ, Pringle SD, Lilley S, Houston AB, Thorburn J. Electrocardiographic changes during cesarean section under regional anesthesia. Anesth Analg. 1992; 74(1):51-6.

Zakowski MI, Ramanathan S, Baratta JB, Cziner D, Goldstein MJ, Kronzon I, et al. Electrocardiographic changes during cesarean section: a cause for concern? Anesth Analg. 1993; 76(1):162-7.

Dogan R, Birdane A, Bilir A, Ekemen S, Tanriverdi B. Frequency of electrocardiographic changes indicating myocardial ischemia during elective cesarean delivery with regional and general anesthesia: detection based on continuous Holter monitoring and serum markers of ischemia. Clin Anesth. 2008; 20(5):347-51.

Roy L, Ramanathan S. ST-segment depression and myocardial contractility during cesarean section under spinal anesthesia. Can J Anaesth. 1999; 46(1):52-5.

Palmer CM, Norris MC, Giudici MC, Leighton BL, DeSimone CA. Incidence of electrocardiographic changes during cesarean delivery under regional anesthesia. Anesth Analg. 1990; 70(1):36-43.

Svanström MC, Biber B, Hanes M, Johansson G, Näslund U, Bålfors EM. Signs of myocardial ischaemia after injection of oxytocin: a randomized double-blind comparison of oxytocin and methylergometrine during Caesarean section. Br J Anaesth. 2008; 100(5):683-9.

Jonsson M, Hanson U, Lidell C, Nordén-Lindeberg S. ST depression at caesarean section and the relation to oxytocin dose. A randomised controlled trial. BJOG. 2010; 117(1):76-83.

Minowa Y, Hara K, Sata T. A case of myocardial ischemia induced by oxytocin during cesarean section. Masui 2013; 62: 982-4.

Smith T. Ethics in medical research. 1st ed. UK: Cambridge University Press; 1999. p. 12–49.

Bhattacharya S, Ghosh S, Ray D, Mallik S, Laha A. Oxytocin administration during cesarean delivery: Randomized controlled trial to compare intravenous bolus with intravenous infusion regimen. joacp 2013; 29(1):32-35

Published
2015-10-03
How to Cite
1.
Shoeibi G, Hoseini H, Marashi S, Yaghooti AA, Jalali M, Ostad Alipour A. Electrocardiographic Changes in Elective Cesarean Delivery after Oxytocin Injection: Regional Anesthesia versus General Anesthesia. AACC. 1(3):72-5.
Section
Research Article(s)