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

Abstract

Background: Spinal anesthesia is a widely used technique for cesarean delivery, but it often results in hypotension, bradycardia, and reduced cardiac output (CO). Atropine has a potent muscarinic receptor antagonist activity in the heart. It may be a good choice to prevent post-spinal bradycardia and minimize the marked CO reduction. Methods: Sixty pregnant women between the ages of 18 and 40 who were ASA-PS II and planned for elective cesarean delivery were divided into two equal groups at random. Both groups received spinal anesthesia. Atropine group (I) (n = 30): patients received 0.01 mg/kg atropine, while control group (II) (n = 30): patients received the same volume of saline. CO measured by electrical cardiometry (EC) was the primary outcome where, heart rate (HR), mean blood pressure (MBP), stroke volume (SV), systemic vascular resistance (SVR), and neonatal outcomes were the secondary outcomes. Results: CO after the intervention was higher in the atropine (group I) than in the control (group II). Also, CO reduction at 5 and 10 min following spinal anesthesia was less in the group I than in the group II. Except for baseline reading, HR was significantly higher in the atropine group versus the control group. MBP was higher in the atropine group than in the control group in all readings. SV and SVR were similar in both groups. Neonatal outcomes were equivalent in both groups. Conclusion: Pre-spinal atropine was effective in preventing post-spinal bradycardia and minimized CO reduction in patients undergoing elective cesarean delivery under spinal anesthesia.