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LETTER TO THE EDITOR

Hyperbaric Bupivacaine and Maternal Hemodynamics

Department of Anesthesiology; University of Texas Medical School at Houston; Houston, Texas; jkatz{at}ucplus.org

To the Editor:

In the recent study by Van de Velde et al. (1). The data presented (1) found no difference in the ultimate height of the sensory block, or the number of blocks that extended higher than T3, in women receiving 6.5 and 9.5 mg of intrathecal bupivacaine. Typically the degree of hypotension after subarachnoid block is thought to be related to the spread of the local anesthetic solution (i.e., the extent of sympathetic blockade). With no difference in spread, how do the authors explain the difference in hemodynamic response?

Subjects in the high-dose group weighed 22 lbs (10 kg) more than subjects in the low dose group. Patient body habitus alters the spread of intrathecal local anesthetics (2), with heavy patients having greater spread. A graph of body habitus to local anesthetic spread might determine whether there was any correlation between weight and anesthetic spread.

REFERENCES

1. Van de Velde M, Van Schoubroeck D, Jani J, et al. Combined spinal-epidural anesthesia for cesarean delivery: dose-dependent effects of hyperbaric bupivacaine on maternal hemodynamics. Anesth Analg 2006;103: 187–90.[Abstract/Free Full Text]
2. Reyes M, Pan PH. Very low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications. Int J Obstet Anesth 2004;13:99–102.[Web of Science][Medline]

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