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.

Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

2015 ◽  
Vol 122 (4) ◽  
pp. 736-745 ◽  
Author(s):  
Warwick D. Ngan Kee ◽  
Shara W. Y. Lee ◽  
Floria F. Ng ◽  
Perpetua E. Tan ◽  
Kim S. Khaw
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Adrenergic Receptor ◽  
Neonatal Outcome ◽  
Computer Controlled ◽  
Double Blinded

Abstract Background: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. Methods: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. Results: Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. Conclusions: When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.

Change of Positional Blood Pressure and Indication of Ephedrine in Hypotension During Spinal Anesthesia for Cesarean Delivery

2013 ◽  
Vol 21 (Number 2) ◽  
pp. 18-23
Author(s):  
Md. A Matin ◽  
J Banu ◽  
K Sultana ◽  
S M Shahana
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Practice ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lateral Position ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
The Mean

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in clinical practice. Certain risk factors play a role in altering the incidence of hypotension. A cross sectional observational study was done on sixty patients undergone cesarean delivery spinal anesthesia in Holy Family Red Crescent Medical College Hospital to evaluate the correlation between pre-anesthetic change of positional blood pressure and predictive necessity of Ephedrine to mange per-operative hypotension. The mean age of the patients included in the study was 25.85 ± 4.24 years and weighted 63.60 ± 6.91 kg (Mean ± sco. The haemodynamic outcomes of the patients are summarized in Table-I as mean systolic blood pressure increased (118 ± 12.02 and 132 ± 14.11 mm of Hg) after change of position from baseline (supine position) to right lateral position. The positional blood pressure varied from 2 to 32 mm of Hg and was observed in 54 patients. But only 35 patients were hypotensive (58.33%) after spinal anesthesia among them only 28 patients required Ephedrine (46.6%). But there was no significant correlation was observed in patients needed Ephedrine who hypotension but not obvious with positional change of pre-anesthetic blood pressure.

scholarly journals Continuous Invasive Blood Pressure and Cardiac Output Monitoring during Cesarean Delivery

2008 ◽  
Vol 109 (5) ◽  
pp. 856-863 ◽  
Author(s):  
Eldrid Langesæter ◽  
Leiv Arne Rosseland ◽  
Audun Stubhaug
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Low Dose ◽  
Dose Infusion ◽  
Phenylephrine Infusion

Background Prevention of hemodynamic instability during cesarean delivery during spinal anesthesia has been the aim of several studies. Noninvasive monitoring has been used in all previous studies. This is the first study in healthy pregnant women with continuous invasive recording of arterial blood pressure, cardiac output, and systemic vascular resistance. The aim of this randomized trial was to compare the effects of two different intrathecal doses of bupivacaine, with or without intravenous phenylephrine infusion, on cardiac output and systolic blood pressure. Methods In this double-blinded study, 80 healthy women scheduled to undergo elective cesarean delivery were randomly assigned to one of four different groups receiving 7 mg spinal bupivacaine with or without a concomitant low-dose infusion of phenylephrine (0.25 microg . kg(-1) . min(-1)) or 10 mg spinal bupivacaine with or without phenylephrine infusion. All patients had 4 microg sufentanil added to the spinal solution and had cohydration with 750 ml saline, 0.9%. Results The low-dose spinal bupivacaine group with intravenous phenylephrine infusion was the most stable group regarding all hemodynamic variables. The authors found significant differences between this group and the group that was given the high dose of bupivacaine with intravenous placebo infusion regarding cardiac output (P = 0.005), systemic vascular resistance (P < 0.0001), and systolic blood pressure (P = 0.012). Conclusions This study shows that low-dose bupivacaine (with sufentanil), combined with a low-dose infusion of phenylephrine and moderate cohydration, gives the best hemodynamic stability during spinal anesthesia for cesarean delivery.

scholarly journals Accuracy of the BoMED NCCOM3 Bioimpedance Cardiac Output Monitor during Induced Hypotension: An Experimental Study in Dogs

1992 ◽  
Vol 20 (3) ◽  
pp. 326-331 ◽  
Author(s):  
J. Tibballs ◽  
M. Hochmann ◽  
A. Osborne ◽  
B. Carter
Keyword(s):  
Cardiac Output ◽  
Resting State ◽  
Cardiac Cycle ◽  
Mean Difference ◽  
The Other ◽  
Limits Of Agreement ◽  
Induced Hypotension ◽  
Electrical Bioimpedance ◽  
The Mean ◽  
Cardiac Output Monitor

Changes in thoracic electrical bioimpedance during the cardiac cycle are utilised by the BoMed NCCOM3 monitor to measure cardiac output (COTEB). The technique provides a continuous noninvasive measurement but it has not been widely accepted. To determine the accuracy of the monitor, we compared its measurement with cardiac output measured by dye dilution (COdd) during induced hypotension and recovery in 23 dogs. After calibration of the NCCOM3 monitor during a resting state in each dog [mean blood pressure 112 ± 17 (SD), mean CODD 3.22 ± 0.99 l/min], the mean difference (COTEB-CODD) between paired measurements at the nadir of hypotension (bloodpressure 55 ± 24 mmHg) was 0.29 ± 0.47 l/min whose limits of agreement (mean difference ± 2 SD) were + 111.8% and -59.1% of the mean hypotensive COdd (110 ± 0.66 l/min). Upon recovery from hypotension (mean blood pressue 102 ± 20 mmHg), the mean difference between paired measurements was -0.28 ± 0.66 l/min, whose limits of agreement were +44.1% and -67.8% of the mean CODD (2.36 ± 1.01 l/min). The mean difference between the two techniques is too variable and excessive to permit substitution of one technique for the other. These results do not support the accuracy and reliability of the BoMed NCCOM3 cardiac output monitor.

Treatment of Hypotension after Hyperbaric Tetracaine Spinal Anesthesia 

1997 ◽  
Vol 86 (4) ◽  
pp. 797-805 ◽  
Author(s):  
Robert F. Brooker ◽  
John F. IV Butterworth ◽  
Dalane W. Kitzman ◽  
Jeffrey M. Berman ◽  
Hillel I. Kashtan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Adrenergic Agonist ◽  
Induced Hypotension ◽  
Alpha Adrenergic Agonist ◽  
Hyperbaric Tetracaine

Background Despite many advantages, spinal anesthesia often is followed by undesirable decreases in blood pressure, for which the ideal treatment remains controversial. Because spinal anesthesia-induced sympathectomy and management with a pure alpha-adrenergic agonist can separately lead to bradycardia, the authors hypothesized that epinephrine, a mixed alpha- and beta-adrenergic agonist, would more effectively restore arterial blood pressure and cardiac output after spinal anesthesia than phenylephrine, a pure alpha-adrenergic agonist. Methods Using a prospective, double-blind, randomized, cross-over study design, 13 patients received sequential infusions of epinephrine and phenylephrine to manage hypotension after hyperbaric tetracaine (10 mg) spinal anesthesia. Blood pressure, heart rate, and stroke volume (measured by Doppler echocardiography using the transmitral time-velocity integral) were recorded at baseline, 5 min after injection of tetracaine, and before and after management of hypotension with epinephrine and phenylephrine. Cardiac output was calculated by multiplying stroke volume x heart rate. Results Five min after placement of a hyperbaric tetracaine spinal anesthesia, significant decrease in systolic (from 143 +/- 6 mmHg to 125 +/- 5 mmHg; P < 0.001), diastolic (from 81 +/- 3 to 71 +/- 3; P < 0.001), and mean (from 102 +/- 4 to 89 +/- 3; P < 0.001) arterial pressures occurred. Heart rate (75 +/- 4 beats/min to 76 +/- 4 beat/min; P = 0.9), stroke volume (115 +/- 17 to 113 +/- 13; P = 0.9), and cardiac output (8.0 +/- 1 l/m to 8.0 +/- 1l/m; P = 0.8) did not change significantly after spinal anesthesia. Phenylephrine was effective at restoring systolic blood pressure after spinal anesthesia (120 +/- 6 mmHg to 144 +/- 5 mmHg; P < 0.001) but was associated with a decrease in heart rate from 80 +/- 5 beats/min to 60 +/- 4 beats/min (P < 0.001) and in cardiac output from 8.6 +/- 0.7 l/m to 6.2 +/- 0.7 l/m (P < 0.003). Epinephrine was effective at restoring systolic blood pressure after spinal anesthesia (119 +/- 5 mmHg to 139 +/- 6 mmHg; P < 0.001) and was associated with an increase in stroke volume from 114 +/- 12 ml to 142 +/- 17 (P < 0.001) and cardiac output from 7.8 +/- 0.6 l/m to 10.8 +/- 1.1 l/m (P < 0.001). Conclusions Epinephrine management of tetracaine spinal-induced hypotension increases heart rate and cardiac output and restores systolic arterial pressure but does not restore mean and diastolic blood pressure. Phenylephrine management of tetracaine spinal-induced hypotension decreases heart rate and cardiac output while restoring systolic, mean, and diastolic blood pressure.

scholarly journals A Clinical Trial on the Effects of Different Regimens of Phenylephrine on Maternal Hemodynamic After Spinal Anesthesia for Cesarean Section

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Mahshid Nikooseresht ◽  
Mohammad Ali Seifrabiei ◽  
Pouran Hajian ◽  
Shadab Khamooshi
Keyword(s):  
Blood Pressure ◽  
Clinical Trial ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Saline Control ◽  
Control Group ◽  
Significant Difference ◽  
The Mean ◽  
Phenylephrine Infusion

Background: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives: The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods: In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results: In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions: The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.

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