Impact of Pre-spinal Atropine on Post Spinal Hemodynamics and Cardiac Output Measured by Electrical Cardiometry in Caesarean Delivery
Condition: Anesthesia
Study type: Interventional
Phase: Phase 3

Summary: 
      Cesarean section is one of the most commonly performed surgical procedures; approximately
      80-90% of elective cesarean sections are conducted using spinal anesthesia . Spinal
      anesthesia is the preferred technique for Cesarean Section (CS) due to its simplicity,
      reliability, low rates of airway complications, facilitation of postoperative analgesia, less
      neonatal exposure to potentially depressant drugs, to awake mother at the time of the birth
      of the child that establishes maternal-infant bonding and successful breastfeeding, and due
      to its low cost as compared to the general anesthesia . The chance of significant maternal
      hypotension is greater with spinal anesthesia than with epidural anesthesia. Left uterine
      displacement with appropriate administration of fluids and use of vasopressor medications can
      minimize the associated hypotension. Intravenous administration of crystalloid or colloid can
      reduce the degree of hypotension after spinal anesthesia for cesarean delivery.

      Maternal hypotension is a frequent side effect of spinal anesthesia for cesarean delivery and
      it causes dangerous maternal and fetal effects . Maternal hypotension decreases
      uteroplacental circulation and it results in nausea, vomiting, bradycardia and different
      systems dysfunction particularly in the presence of other diseases as renal, hepatic, cardiac
      and neurological. Anesthesiologists should not allow hypotension to continue, this often
      requires the use of vasopressors to maintain blood pressure as ephedrine, phenylephrine and
      norepinephrine .

      Cardiac output is the amount of blood pumped by the heart per unit of time and is determined
      by four factors: two factors that are intrinsic to the heart-heart rate and myocardial
      contractility-and two factors that are extrinsic to the heart -preload and afterload. Heart
      rate is defined as the number of beats per minute and is mainly influenced by the autonomic
      nervous system. Increases in heart rate escalate cardiac output if ventricular filling is
      adequate during diastole .

      Atropine is an anticholinergic agent with its ability to treat bradycardia both in mother and
      fetus. Atropine is an anti-sialagogue as well as used to antagonize the muscarinic side
      effects of anticholinesterases. Atropine is detected in the umbilical circulation within 1 to
      2 minutes of maternal administration, and an F/M ratio of 0.93 is attained at 5 minutes .
    


Intervention name(s): atropine; Isotonic saline
Intervention type(s): Drug; Drug
Intervention description(s): patients will receive 0.01 mg/kg intravenous atropine in 5 ml normal saline 0.9 % before induction of spinal anaesthesia; patients will receive the same volume of isotonic saline 0.9% 5ml (control group) before induction of spinal anaesthesia
Intervention MeSH terms: Atropine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment