Impact of pre-spinal atropine on post spinal hemodynamic and cardiac output measured by electrical cardiometry in cesarean delivery, a randomized controlled trial

Figures & data

Figure 1. Flow chart of the studied cases.

Table 1. Demographic and operative characteristics of the study groups.

Variables		Group I (Total=30)	Group II (Total=30)	p-value
Age (years), Mean±SD		27.5±5.0	29.1±5.4	^.239
Weight (kg), Mean±SD		66.8±3.8	67.2±4.2	^.687
Height(cm)		172.1±5.0	171.9±5.3	^.861
BMI (kg/m^2), Mean±SD		22.6±1.0	22.8±1.0	^.456
The cesarean section number, (n, %)	First	12 (4.0%)	11 (36.7%)	#0.791
	Repeated	18 (6.0%)	19 (63.3%)
Gestational age (weeks), Mean±SD		38.9±.6	38.8±.6	^.412
Induction-delivery time (min.), Mean±SD		18.1±3.2	17.9±2.7	^.828
Operation duration (min.), Mean±SD		83.2±13.9	81.7±13.7	^.676

BMI: Body mass index. ^Independent t-test. #Chi square test

Figure 2. HR, MBP, SV and CO changes during specific times A-HR, B – MBP, C-SV, D-CO.

Table 2. Comparison regarding heart rate, mean blood pressure, and total ephedrine consumption.

Time	Group I (Total=30)	Group II (Total=30)	^p-value	Relative effect (Atropine relative to control)
				Mean±SE	95% CI
Heart rate (beat/min.), Mean±SD
Baseline (T1)	95.9±3.4	96.5±2.3	0.399	−0.6±0.7	−2.1–0.9
5 minutes after intervention (T2)	114.1±3.5	96.3±2.6	<0.001*	17.8±0.8	16.2–19.4
5 minutes after spinal (T3)	86.0±2.7	73.1±6.4	<0.001*	12.9±1.3	10.3–15.4
10 minutes after spinal (T4)	86.8±3.2	70.9±5.5	<0.001*	15.9±1.2	13.6–18.2
5 minutes after delivery (T5)	117.9±3.4	98.6±2.9	<0.001*	19.3±0.8	17.7–20.9
At the end (T6)	114.7±3.2	95.4±3.0	<0.001*	19.3±0.8	17.7–20.9
Bradycardia (n, %)	0 (0.0%)	6 (20.0%)	§0.024*	NA	NA
Mean Blood Pressure (mmHg), Mean±SD
Baseline (T1)	92.7±7.1	91.8±6.0	0.626	0.8±1.7	−2.6–4.2
5 minutes after intervention (T2)	92.4±7.0	91.5±5.7	0.615	0.8±1.6	−2.5–4.1
5 minutes after spinal (T3)	80.1±6.0	69.8±5.4	<0.001*	10.3±1.5	7.4–13.3
10 minutes after spinal (T4)	86.1±6.0	75.1±5.3	<0.001*	11.1±1.5	8.1–14.0
5 minutes after delivery (T5)	92.3±6.1	84.2±5.5	<0.001*	8.0±1.5	5.0–11.0
At the end (T6)	95.4±6.3	87.5±5.6	<0.001*	8.0±1.5	4.9–11.1
Ephedrine consumption, Mean±SD
Total Ephedrine dose (mg)	5.9±2.0	18.3±5.1	<0.001*	−12.4±1.0	−14.4–-10.4

^Independent t-test. §Fisher’s Exact test. NA: Not applicable. SE: Standard error. CI: Confidence interval. *Significant.

Table 3. Comparison regarding cardiac output, systemic vascular resistance, and stroke volume.

Time	Group I (Total=30)	Group II (Total=30)	^p-value	Relative effect (Atropine relative to control)
				Mean±SE	95% CI
Stroke volume (mL), Mean±SD
Baseline (T1)	82.5±7.5	83.0±9.0	0.840	-0.4±2.1	-4.7–3.8
5 minutes after intervention (T2)	83.3±7.7	83.7±9.0	0.854	-0.4±2.2	-4.7–3.9
5 minutes after spinal (T3)	62.6±5.0	63.3±5.8	0.621	-0.7±1.4	-3.5–2.1
10 minutes after spinal (T4)	60.4±5.1	61.0±5.9	0.692	-0.6±1.4	-3.4–2.3
5 minutes after delivery (T5)	99.2±5.5	99.3±5.8	0.927	-0.1±1.5	-3.0–2.8
At the end (T6)	101.6±5.6	102.0±5.7	0.784	-0.4±1.5	-3.3–2.5
Systemic Vascular Resistance (dyn/cm^2), Mean±SD
Baseline (T1)	816.8±72.8	806.4±64.5	0.563	10.3±17.8	-25.2–45.9
5 minutes after intervention (T2)	819.4±72.9	808.2±65.7	0.534	11.2±17.9	-24.7–47.1
5 minutes after spinal (T3)	665.0±17.3	663.2±15.1	0.664	1.8±4.2	-6.6–10.2
10 minutes after spinal (T4)	684.0±23.1	679.8±24.4	0.500	4.2±6.1	-8.1–16.5
5minutes after delivery (T5)	700.4±25.1	690.5±27.7	0.153	9.9±6.8	-3.8–23.5
At the end (T6)	678.3±25.8	669.3±26.7	0.190	9.0±6.8	-4.6–22.6
Cardiac Output (mL/min.), Mean±SD
Baseline (T1)	7.9±0.8	8.0±0.8	0.662	-0.1±0.2	-0.5–0.3
5 minutes after intervention (T2)	9.5±0.9	8.1±0.8	<0.001*	1.4±0.2	1.0–1.9
5 minutes after spinal (T3)	5.4±0.4	4.7±0.4	<0.001*	0.6±0.1	0.4–0.9
10 minutes after spinal (T4)	5.2±0.4	4.4±0.3	<0.001*	0.9±0.1	0.7–1.1
5 minutes after delivery (T5)	11.7±0.6	9.8±0.6	<0.001*	1.9±0.2	1.6–2.2
At the end (T6)	11.6±0.6	9.7±0.6	<0.001*	1.9±0.2	1.6–2.2

^Independent t-test. SE: Standard error. CI: Confidence interval. *Significant.

There was no significant difference between the two groups regarding APGAR score at 1 and 5 min. also, umbilical artery ABG values were equivalent in both groups. (Table 4).

Table 4. Comparison regarding neonatal APGAR score and umbilical artery ABGs.

Variables	Group I (Total=30)	Group II (Total=30)	^p-value	Relative effect (Atropine relative to control)
				Mean±SE	95% CI
APGAR 1	7.5±0.9	7.7±0.7	0.343	−0.2±0.2	−0.6–0.2
APGAR 5	9.0±0.6	9.1±0.4	0.445	−0.1±0.1	−0.4–0.2
PH	7.32±0.00	7.32±0.01	0.779	0.00±0.00	0.00–0.00
Base deficit	0.77±0.06	0.78±0.07	0.430	−0.01±0.02	−0.05–0.02
Bicarbonate level	22.8±0.4	23.0±0.4	0.056	−0.2±0.1	−0.4–0.0

^Independent t-test. SE: Standard error. CI: Confidence interval.