The Effect of spinal anesthesia on sensory and motor block in cesarean cases with a diagnosis of gestational diabetes mellitus

TL;DR

This study shows that spinal anesthesia in cesarean cases for women with gestational diabetes leads to longer sensory and motor block durations and altered cardiovascular responses.

Contribution

The study identifies prolonged sensory and motor block durations and altered cardiovascular responses in GDM patients under spinal anesthesia.

Findings

GDM patients had significantly prolonged sensory and motor block durations compared to non-GDM patients.

GDM patients showed higher heart rates and increased mean arterial pressure at specific post-anesthesia time points.

Abstract

Gestational diabetes mellitus (GDM) poses challenges in managing anesthesia, particularly during cesarean sections where spinal anesthesia is commonly used. Physiological changes associated with GDM, such as neuropathy and cardiovascular complications, can influence the effectiveness and outcomes of anesthesia. This study aimed to compare the cardiovascular and respiratory responses, as well as the durations of sensory and motor blocks, in patients with GDM and those without undergoing cesarean sections under spinal anesthesia.

This prospective, controlled, observational study was conducted at Giresun Women’s Health and Research Hospital from April 2023 to August 2024. A total of 56 patients (28 with GDM and 28 without) undergoing elective cesarean section with spinal anesthesia were enrolled. Spinal anesthesia was administered using a standard dose of local anesthetic (12 mg of 0.5% hyperbaric bupivacaine). The recovery durations of sensory and motor blocks, the time to first postoperative analgesic requirement, and hemodynamic parameters (heart rate and blood pressure) were recorded.

Patients with GDM demonstrated significantly prolonged sensory and motor block durations compared to non- GDM patients (p<0.05). Furthermore, GDM patients exhibited delayed cardiovascular responses, presenting significantly higher heart rates at the 10th minute and increased mean arterial pressure (MAP) at the 30th and 45th minutes.

This study indicates that patients with GDM experience extended block durations and altered cardiovascular responses, highlighting the necessity for tailored anesthesia protocols. Larger multicenter studies are required to validate these findings and explore the impacts of other anesthesia types, such as epidural and general anesthesia.