Article type: Research Article
Authors: George, R.B.a; b; *; 1 | DesRoches, J.c; 2 | Abdo, I.b; d; 3 | Lehmann, C.b; e; f; 4
Affiliations:
[a] Department of Women’s & Obstetric Anesthesia, IWK Health Centre, Halifax, NS, Canada |
[b] Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada |
[c] Dalhousie University School of Medicine, Halifax, NS, Canada |
[d] Department of Anesthesiology and Intensive Care Medicine, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Czech Republic |
[e] Department of Pharmacology, Dalhousie University, Halifax, NS, Canada |
[f] Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
Correspondence:
[*]
Corresponding author: Dr. R.B. George, IWK Health Centre, Department of Women’s & Obstetric Anesthesia, 5850/5980 University Avenue. P.O. Box 9700, Halifax, B3K 6R8 NS, Canada. Tel.: +1 902 470 6627; Fax: +1 902 470 6626; rbgeorge@dal.ca
Note: [1] Ronald B. George, MD FRCPC – Dr. George was involved in the conception and design of the study. He analyzed and interpreted the data, created tables and figures, drafted and revised the manuscript.
Note: [2] Jaclyn DesRoches, BScN, RN – Ms. DesRoches assisted in the submission of the REB documents, data collection, analysis, and drafting of the manuscript.
Note: [3] Islam Abdo, MD – Dr. Abdo assisted in the data collection, analysis, and interpretation and drafting of the manuscript.
Note: [4] Christian Lehmann, MD FRCPC – Dr. Lehmann was involved in the conception and design of the study, data analysis and interpretation and revising the manuscript.
Abstract:
BACKGROUND: Pregnancy places significant demands on the cardiovascular system leading to measurable changes in the macrocirculation and potentially the microcirculation. During labour, both uterine contractions and labour pain can further impact cardiovascular status. The objective of this observational study was to compare sublingual microcirculation in labouring parturients before and after epidural analgesia.
METHODS: Healthy pregnant, labouring women requesting epidural analgesia were approached to participate. Participants with cardiovascular disease, diabetes, obesity, smoking or caffeine intake were excluded. The sidestream dark field device was applied to the sublingual mucosa obtaining images of at least 20 seconds in 5 visual fields before and after epidural analgesia. Video clips were analyzed randomly and blindly. The primary outcome was mean microvascular flow index (MFI).
RESULTS: Twelve participants completed this study. The results demonstrate no statistically significant difference in the MFI during labour pain (2.9±0.1) compared to after epidural analgesia (3.0±0.04, p = 0.31). Furthermore, there were no statistically significant differences in any secondary outcomes.
CONCLUSION: Our findings indicate that epidural analgesia may not impact sublingual microcirculation in labouring women. This agrees with literature supporting epidural analgesia as a safe, appropriate method of pain relief during labour with limited impact on peripheral macro or microcirculation.
Keywords: Microcirculation, epidural, sidestream dark field imaging
DOI: 10.3233/CH-141851
Journal: Clinical Hemorheology and Microcirculation, vol. 60, no. 4, pp. 389-395, 2015
