Arterial hypotension refers to the frequent complications of spinal anesthesia during cesarean delivery. Expressed anxiety before the operation of caesarean section, can contribute to the occurrence of arterial hypotension during CA. Juvenile pregnant women are characterized by a high level of anxiety. Determination of the level of α-amylase of saliva is a simple and non-invasive way of an objective assessment of the intensity of stress. Objective: To develop an algorithm for predicting arterial hypotension in spinal anesthesia during cesarean section in young primiparas. Materials and methods of research. After the approval of the ethical committee of the FSBU VO “Amurskaya GMA” of September 21, 2016. Clinical research on the topic “Anesthesia of delivery of young patients” conducted a prospective observational study of 43 pregnant women aged 14 to 18 years, on the basis of the regional perinatal center of GAUZ JSC “AOKB” in the period from 2016 to 2017. Primary endpoints of the study included a level of salivary α-amylase (AAS) recorded at resting patients (baseline level) and on the operating table immediately before anesthesia, as well as an assessment of anxiety and depression on the HADS scale performed on the eve of delivery. The parameters of hemodynamics (blood pressure and heart rate) were recorded on the eve of delivery, before performing spinal anesthesia, and the lowest level of blood pressure during the operation was noted. The level of α-amylase was determined by a Labio 200 (Mindray), using the “alfa-AMY” reagent, kinetic method on photometric systems. Results. In the presence of clinically significant anxiety on the HADS scale in the patient, the level of AAS before the operation increases by almost a quarter of the initial level, whereas in patients with anxiety scores less than 11 points, the percentage increase in AAS is 2 times less. The maximum decrease in blood pressure and blood pressure in patients during the operation of a cesarean section with an anxiety score above 11 points is on average 37-38% of the initial, while in patients with no clinically significant anxiety, the blood pressure increase is on average 17.5%. The difference between the mean absolute values of AAS levels at rest and before the operation in patients of the above 2 subgroups was also expressed. Сonclusion. The level of amylase has a strong associative relationship with the scale of anxiety and depression of HADS. The algorithm developed by us, which includes preoperative levels of salivary α-amylase and systolic blood pressure, allows us to predict the likelihood of intraoperative hypotension in a particular patient.
Endothelial Activation and Cell Adhesion Molecule Concentrations in Pregnant Women Living at High Altitude
