Effect of Different Types of Anesthesia on Perioperative Brain Natriuretic Peptide Levels in Parturient Cardiac Patient Undergoing Elective Cesarean Section
Condition: General Anesthesia Versus Spinal Anesthesia on BNP Hormone Levels Preoperatively and Postoperatively in Parturient Cardiac Patient Undergoing C.S
Study type: Observational [Patient Registry]

Summary: 
      comparing the effect of general anesthesia versus spinal anesthesia on brain natruretic
      peptide hormone levels preoperatively and postoperatively in parturient cardiac patient
      undergoing cesarean section
    

Detailed description: 
      In our study, investigators will detect changes in brain natruretic peptide (BNP) levels in
      parturient patients at risk undergoing cesarean section, in relation to type of anesthesia
      used, general anesthesia versus spinal anesthesia, in order to evaluate the safety of type of
      anesthesia used for this kind of patient.

      It is very important to assess and predict risk in the cardiovascular system in such cases. A
      number of cardiac indexes for predicting risk have been developed like Goldman Multifactorial
      risk index, Eagle's risk index and Detsky's cardiac index. It is recommended to evaluate
      patients using these indexes and to institute preoperative medical treatment based on the
      results. These clinical scoring systems, although simple to use, are somewhat inconvenient
      and have limitations in their predictive value, whereas other cardiac investigations such as
      exercise or pharmacologic stress imaging are sensitive, but limited in practice by time and
      resources. Recently brain natriuretic peptide (BNP) was spotlighted as a predictor for
      diagnosing and predicting the prognosis of various heart diseases. BNP is a cardiac hormone
      that is synthesized by ventricular myocytes in response to ventricular dysfunction. Recent
      studies have demonstrated that elevated serum BNP levels predict first cardiovascular event
      and death in the general population. In addition, it has been reported that BNP measured
      before major surgery can be used as a predictor of postoperative cardiac complications.
    

Intervention name(s): G.A Group A:
Intervention type(s): Diagnostic Test
Intervention description(s): G.A will be conducted After pre-oxygenation for 3-5 minutes. thiopental (5 mg/kg) will be administered I.V, followed by succinylcholine 1.5 mg/kg. After tracheal intubation, the patients will be ventilated with 100% oxygen. isoflurane 0.8% will be added, to maintain the anesthesia. Further neuromuscular block will be maintained by using atracurium . After delivery of the fetus, fentanyl IV will be given 1ug/kg as analgesia and 20 IU oxytocin will be given by I.V infusion .Reverse neuromuscular blockade as necessary at completion of surgery. Extubate when the patient is awake
In the sitting position and after complete asepsis , 2-3 ml of Lidocaine will be injected subcutaneously, spinal anesthesia will be performed at interspace L3-4 or L4-5, midline approaches using 22 guage Quinke needle . 2.5 ml of hyperbaric bupivacaine 0.5% in addition to 25 μg fentanyl will be injected into the subarachnoid space after successful dural puncture and confirmation by barbotage.
Other intervention name(s): Spinal A Group B:
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Parturient cardiac patient 20-50 years old undergoing cesarean section with

          -  Mild to moderate valvular heart lesions.

          -  Cardiomyopathic lesions with ejection fraction > 40%

          -  Ischemic heart disease

          -  Hypertension

          -  Non-fatal arrhythmias eg. Controlled AF