Maternal hypouricemia was associated with a significantly higher incidence of post-spinal hypotension compared to normal serum uric acid levels (p < 0.02) and an increased need for vasopressors.
Observational (n=200)
Does hypouricemia predict an increased incidence of post-spinal hypotension and need for vasopressors in pregnant women undergoing spinal anesthesia for cesarean section?
Maternal hypouricemia prior to cesarean delivery is associated with a higher incidence of post-spinal hypotension and an increased need for vasopressors.
Absolute Event Rate: 75% vs 25%
p-value: p=<0.02
Introduction: Adenosine, ADP, and ATP, and, to a lesser extent, UTP are well-known intracellular constituents, intimately involved in all aspects of cell function acting as enzyme cofactors, sources of energy, and building blocks for DNA. The metabolic pathways linking ATP, ADP, AMP, and adenosine and the potential for each of these purines to elicit distinct receptor-mediated effects on cell function form the basis of a complex, physiologically relevant, purinergic cascade comparable to those involved blood clotting and complement activation.Concentration of purines as neurotransmitters, may be correlated with characteristics of neuraxial block in spinal anesthesia. Methods: We examined 200 pregnant women, who before starting spinal anesthesia for cesarean section was performed over the fence of venous blood. In all patients, along with generally accepted clinical, instrumental and laboratory tests, spectrophotometric determination of the concentrations of adenine, guanine, hypoxanthine, xanthine, uric acid, and malondialdehyde was carried out in samples of venous blood. Take into account the following characteristics of spinal anesthesia administered dose of bupivacaine, speed of onset, depth and height of the spread of spinal block, the need for additional intravenous administration of phenylephrine or norepinephrine. Results: Incidence of post-spinal hypotension was significantly higher in women who had hypouricemia as compared with those with normal serum uric acid levels (25% vs 75%; p < 0.02). Mean serum uric acid levels were significantly lower (p < 0.001) in patients requiring high dose of vasopressors than in those requiring moderate to low dose of vasopressors. Elevated serum uric acid levels is associated with lower incidence of post-spinal hypotension and reduced need of vasopressors. Conclusions: In parturients undergoing cesarean delivery, maternal hypouricemia is associated with higher incidence of post-spinal hypotension and elevated need of vasopressors, hyperuricemia is associated with lower need of vasopressors.
Oreshnikov et al. (Sun,) conducted a observational in Pregnant women undergoing cesarean section with spinal anesthesia (n=200). Hypouricemia vs. Normal serum uric acid levels was evaluated on Incidence of post-spinal hypotension (p=<0.02). Maternal hypouricemia was associated with a significantly higher incidence of post-spinal hypotension compared to normal serum uric acid levels (p < 0.02) and an increased need for vasopressors.