scholarly journals Accuracy and trending abilities of finger plethysmographic blood pressure and cardiac output compared to invasive measurements during caesarean delivery in healthy women: an observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ivar N. Omenås ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Observational Study ◽  
Caesarean Delivery ◽  
Healthy Women

scholarly journals Accuracy and trending abilities of finger plethysmographic blood pressure and cardiac output compared with invasive measurements during caesarean delivery in healthy women. An observational study.

2020 ◽  
Author(s):  
Ivar Nagelgaard Omenås ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Caesarean Delivery ◽  
Limits Of Agreement ◽  
Polar Plot ◽  
Non Invasive ◽  
Healthy Women ◽  
Cardiac Output Measurements

Abstract Background: In women presenting for caesarean section under spinal anaesthesia, continuous measurement of circulatory aspects, such as blood pressure and cardiac output, is often needed. At present, invasive techniques are used almost exclusively. Reliable non-invasive monitors would be welcome, as they could be safer and less uncomfortable, while easy and quick to apply. We aimed to evaluate whether a non-invasive, finger plethysmographic device, the ccNexFin monitor, can replace invasively measured blood pressure in the radial artery, and whether cardiac output measurements from this device can be used interchangeably with measurements from the mini-invasive LiDCO monitor, currently in use at our institution. Methods: Simultaneous invasive measurements were compared with ccNexFin in 23 healthy women during elective caesarean section under spinal anaesthesia. We used Bland Altman statistics for assessing agreement, and polar plot methodology for judging trending abilities with pre-defined limits. Results: Mean arterial and systolic pressures showed biases (invasive – ccNexFin) of -4.3 and 12.2 mmHg, with limits of agreement of -15.9 – 7.4 and -11.1 – 35.6, respectively. The ccNexFin trending abilities were within suggested limits for mean pressure, but insufficient for systolic pressure compared with invasive measurements. Cardiac output had a small bias of 0.2 L/min, but wide limits of agreement of -2.6 – 3.0. The ccNexFin trending abilities compared with the invasive estimated values (LiDCO) were unsatisfactory. Conclusions: We consider the ccNexFin monitor to have sufficient accuracy in measuring mean arterial pressures. The limits of agreement for systolic measurements were wider, and the trending ability, compared with invasive measurements, was outside the recommended limit. The ccNexFin is not reliable for cardiac output measurements or trend in pregnant women for caesarean delivery under spinal anaesthesia.

scholarly journals Norepinephrine versus phenylephrine for maintenance of blood pressure during spinal anaesthesia for caesarean delivery - A randomized double blind controlled study

2021 ◽  
Vol 8 (3) ◽  
pp. 460-464
Author(s):  
Devyani Desai ◽  
Bhoomika Kalarthi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Spinal Anaesthesia ◽  
Caesarean Delivery ◽  
Controlled Study ◽  
Double Blind ◽  
Significant Difference

: Currently phenylephrine is a preferred 1 line vasopressor for maintenance of blood pressure during spinal anaesthesia, may be associated with reflex bradycardia and decreased cardiac output, posing risk to mother or foetus. Norepinephrine may be an useful alternative as being potent alpha with weak beta adrenergic agonist activity. : This study compared the effectiveness of prophylactic and treatment boluses of norepinephrine and phenylephrine to maintain systolic blood pressure at or above 80% of baseline value during spinal anesthesia for cesarean delivery with the primary aim to compare cardiac output. Secondary aims were total doses of study drug required, neonatal outcome and perioperative complications.: Total 100, term pregnant women with ASA status II undergoing caesarean delivery under spinal anaesthesia were enrolled in this prospective, double blind controlled study. Patients were randomized to receive prophylactic bolus dose of norepinephrine (6 µg) or phenylephrine (100 µg) immediately after spinal anaesthesia. Systolic blood pressure, cardiac output and heart rate were monitored. Intermittent bolus doses were repeated whenever required. Student ‘t’ test and chi square test were used for analysing the data. : Both the drugs were able to maintain the systolic blood pressure ≥ 80% of baseline (p=0.356). Significant difference observed in cardiac output while comparing both the groups from 3 to 15 minutes after spinal anesthesia (p=0.014). The incidence of bradycardia was lower in norepinephrine group as compared to phenylephrine group (P=0.018). : Norepinephrine is as effective as phenylephrine for maintenance of blood pressure after spinal anaesthesia for caesarean delivery with stable heart rate and cardiac output.

scholarly journals Blood pressure and cardiac output during caesarean delivery under spinal anaesthesia: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046102
Author(s):  
Trond Melbye Michelsen ◽  
Christian Tronstad ◽  
Leiv Arne Rosseland
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Cohort Study ◽  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Prospective Cohort ◽  
Caesarean Delivery ◽  
Elective Caesarean Section ◽  
Secondary Outcome

ObjectivesWe have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery.DesignProspective cohort study.SettingTertiary hospital in Norway.Participants76 healthy women with uneventful pregnancies undergoing an elective caesarean section.InterventionsWe induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion.Primary and secondary outcome measuresPrimary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery.ResultsMedian age at delivery was 34.5 (range 21–43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56–7.54) L/min before spinal anaesthesia and 6.40 (5.83–7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1–142.7) mm Hg to 134.1 (124.0–146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001).ConclusionsMaternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia.Trial registration numberNCT00977769.

scholarly journals A three minutes supine position test reveals higher risk of spinal anesthesia induced hypotension during cesarean delivery. An observational study.

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1028 ◽  
Author(s):  
Markos Erango ◽  
Arnoldo Frigessi ◽  
Leiv Arne Rosseland
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Observational Study ◽  
Pregnant Women ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Supine Position ◽  
The Other ◽  
Induced Hypotension ◽  
The Mean

Background: Cesarean delivery is performed under spinal anesthesia, and vasodilation is the main cause for a drop in blood pressure. The compression of the aorta and inferior vena cava by the gravid uterus is of additional clinical importance. Hypotension may occur during cesarean delivery even if prophylactic infusion of phenylephrine is practiced. We have tested if a 3 minute supine observation, can identify a subset of women with decreasing systolic arterial pressure (SAP) under spinal anesthesia. Methods: We performed a prospective observational study at Oslo University Hospital on healthy pregnant women for planned cesarean delivery. Continuous measurements of calibrated invasive SAP and estimated cardiac output were recorded for 76 women in a 3 minutes measurement with the woman in the left lateral position, followed by supine position for 3 minutes. Using functional data clustering, principal component analysis and curve smoothing, to filter way noise and reduce the dimensionality of the signal, we clustered the women into separate SAP groups.   Results: We identified two significantly different groups of women during supine position; one characterized by initial drop in SAP, the other showed initial increase. After spinal anesthesia, the mean SAP curve of the women in the first group showed a drop in blood pressure, which was more rapid than for the other women. A minor difference in cardiac output was observed between the two groups of women with the mean cardiac output curve for the first group being higher. Conclusions: This work indicates that supine position affect clinically relevant cardiovascular measurements in pregnant women. A simple test may identify patients with increased risk of spinal anesthesia induced hypotension.

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