The effect of type of anesthesia (general versus spinal) on postoperative levels of brain natriuretic peptide in parturient women with cardiovascular diseases undergoing cesarean section and related cardiac impacts

ABSTRACT

Background

Dealing with parturient women with cardiac disease is still a challenge for anesthesiologists due to the presence of physiologic burden of pregnancy in addition to the already existing compromised cardiovascular system. A variety of cardiac indices have been utilized to forecast the risk of perioperative cardiac complications, yet limitations in their predictive value exist. Perioperative brain natriuretic peptide (BNP) level is used as a prognosticator of cardiac complications following surgery in cardiac and non-cardiac individuals.

Aim of study

To compare the effect of general and spinal anesthesia during cesarean section in parturient with cardiac disease on BNP levels and on predicting adverse cardiac events.

Methods

Thirty cardiac parturient with cesarean section were assigned randomly into two groups of equal size. Group A: participants received general anesthesia (GA); Group B: participants received spinal anesthesia. Preoperative and 2 and 24 h postoperative BNP levels were measured. Intraoperative and 24 h postoperative cardiac complications were observed.

Results

Preoperative and 2 and 24 h postoperative BNP mean levels were similar in the two groups. In each group, the 2 and 24 h postoperative rise in BNP mean levels was insignificant compared to the preoperative mean levels of BNP. Incidence of complications was comparable in both groups, but it was associated with the already high preoperative levels of BNP.

Conclusions

The study concludes that safely conducted certain type of anesthesia has no effect on the perioperative BNP levels nor incidence of complications which is associated with the already high preoperative BNP levels.

KEYWORDS:

• BNP
• anesthesia
• cardiac
• parturient
• cesarean section

Authors’ contributions

Heba Omer and Michael Wahib contributed to the conception and design of the study, analysis of the data and writing the manuscript.

Sahar Marzouk, Ahmed Abdalla, Ashraf Mohamed Abdelreheem and Mohamed Hussein Helmy collected the data and wrote the manuscript.

Sahar Marzouk, Ahmed Abdalla, Ashraf Mohamed Abdelreheem, Mohamed Hussein Helmy, Heba Omar and Michael Wahib revised the manuscript and contributed to the approval of final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval and consent to participant

• Ethical approval was obtained from Cairo University hospitals research committee (N-2-2018). Approval date: 17-2-2018.

• Study was conducted at Kasr Al Ainy Hospital.

• Written informed consents were obtained from participants before inclusion.