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LETTER TO THE EDITOR

Hyperbaric Bupivacaine and Maternal Hemodynamics

Department of Anesthesiology; UZ Leuven; Leuven, Belgium; marc.vandevelde{at}uz.kuleuven.ac.be

In Response:

We thank Drs. Katz and Panni (1) for their interest in our work (2). The aim of our study was to demonstrate the better hemodynamic profile associated with low-dose spinal anesthesia for cesarean delivery as compared with higher doses. As suggested, the spread of local anesthetic might influence the degree of hypotension. However, we could not identify such a correlation in our trial. We measured the spread of local anesthetic using absence or presence of cold sensation. The test may not have been sensitive enough to detect modest differences. Our results might have been different if we would have used a different sensory modality such as light touch or pinprick.

Drs. Katz and Panni ask whether differences in patient weight were important. We agree that body habitus might influence local anesthetic spread as in the case report cited in their Letter, but the literature suggests only a weak correlation between weight and local anesthetic spread within the "normal" (body mass index <35) pregnant patient population (3). Reanalysis of our data does not suggest any correlation between patient weight and anesthetic spread.

REFERENCES

1. Katz J, Panni MK. Hyperbaric bupivacaine and maternal hemodynamics. Anesth Analg 2007;104:454.[Free Full Text]
2. 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]
3. Pitkanen MT. Body mass and spread of spinal anesthesia with bupivacaine. Anesth Analg 1987;66:127–31.[Web of Science][Medline]

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