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Arrhythmias during spinal anesthesia for Cesarean section

^* From the Department of Anesthesiology and Section of Cardiology, Ton Yen General Hospital, Hsin Chu, Taiwan.

Address correspondence to:Dr. Chih-Long Shen, 69, Second Shen-Chen Rd, Department of Anesthesiology, Ton Yen General Hospital, Chu Pei, Hsin Chu, 302-42 Taiwan. Phone: 886-3-5527000 Ext 1201; Fax: 886-3-5516585; E-mail: yuchun51{at}ms22.hinet.net

Purpose: Spinal block has long been considered a safe anesthesia technique for surgery. However, severe bradycardia, cardiac arrest, and other arrhythmias during spinal anesthesia have been reported and the incidence of intraoperative arrhythmias is not well established. In this study the incidence of arrhythmias during spinal anesthesia was determined.

Methods: We studied 254 healthy women undergoing Cesarean section under spinal anesthesia prospectively. Spinal anesthesia with 10 mg bupivacaine mixed with 0.2 mg morphine was performed at the L_3-4 interspace. Intraoperative arrhythmias were recorded and verified later by a cardiologist.

Results: First degree atrioventricular block developed in nine patients (3.5%), second degree atrioventricular block in nine (3.5%), severe bradycardia (heart rate < 50 beats•min^–1) in seventeen (6.7%), multiple VPC in three (1.2%). The height and weight of patients with severe bradycardia, multiple VPCs, or atrioventricular block were not different from those of the other patients. However, the age of patients in the potentially dangerous arrhythmias group was greater than that in the other group (P = 0.006).

Conclusion: The incidence of arrhythmias as well as hypotension during spinal anesthesia for Cesarean section was higher than expected. Although most of these arrhythmias were transient and recovered spontaneously, they might unexpectedly occur and sometimes need immediate and prompt treatment. It is necessary to remain vigilant during spinal anesthesia for Cesarean section and careful monitoring of these patients is warranted, especially in older parturients.

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