Pulse Transit Time Variability Predicts Severe Hypotension after Spinal Anesthesia for Elective Cesarean Delivery

2013 ◽  
Vol 753-755 ◽  
pp. 2208-2213
Author(s):  
Lei Sun ◽  
Chao Huang ◽  
Yan Shen ◽  
Xiu Quan Fu ◽  
Yi Hu ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Transit Time ◽  
Physiological Mechanism ◽  
Pulse Transit Time ◽  
Preoperative Assessment ◽  
Time Variability ◽  
Elective Cesarean Delivery ◽  
Severe Hypotension ◽  
Elective Cesarean

Hypotension after spinal anesthesia for elective cesarean delivery may be harmful. This article first proposed pulse transit time variability (PTTV) analysis could be applied in the preoperative assessment of its risk. 42 patients were classified into groups of Mild, Moderate and Severe. Frequency domain analysis was performed on the day before surgery using autoregressive model. We divided the frequency band according to the troughs and extracted relevant parameters of power spectrum, while differences between groups were evaluated by t-test. The results indicating significant differences are presented in PR5, PR1/PR5, PR3/PR5 and PR4/PR5, with their discriminant accuracy on the 42 patients reaching 80.77% in low-BP group and 75% in norm-BP group. We conclude PTTV analysis can help predict the risk of hypotension on the day before surgery and the physiological mechanism is mainly due to parasympathetic regulation.

β2-Adrenoceptor Genotype Affects Vasopressor Requirements during Spinal Anesthesia for Cesarean Delivery

2006 ◽  
Vol 104 (4) ◽  
pp. 644-650 ◽  
Author(s):  
Richard M. Smiley ◽  
Jean-Louis Blouin ◽  
Maria Negron ◽  
Ruth Landau
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Analysis Of Variance ◽  
Genetic Variants ◽  
Response To Treatment ◽  
Elective Cesarean Delivery ◽  
Hyperbaric Bupivacaine ◽  
Wide Variability ◽  
Elective Cesarean ◽  
Vasopressor Use

Background Maternal hypotension is common after spinal anesthesia for cesarean delivery. There is wide variability in the incidence and severity of hypotension and in the response to treatment. The beta2 adrenoceptor (beta2AR) possesses several polymorphic sites. Codons 16 (Arg16Gly) and 27 (Glu27Gln) have been shown to affect desensitization of the receptor. The goal of this study was to determine whether genetic variants of the beta2AR alter incidence of hypotension or the amount of vasopressor treatment required during spinal anesthesia for cesarean delivery. Methods One hundred seventy healthy women undergoing elective cesarean delivery were studied. Spinal anesthesia was performed with 12 mg hyperbaric bupivacaine, 25 microg fentanyl, and 200 microg morphine. Hypotension was treated with ephedrine and/or phenylephrine intravenously, and beta2AR genotype at codons 16 and 27 was determined. Analysis of variance was used to compare variables between genotypes, with data expressed as mean +/- SD. Results Ephedrine or phenylephrine was used in more than 90% of patients, with no difference in the incidence of hypotension between beta2AR genotypes. However, there was a significant effect of genotype on the amount of vasopressor required. Gly16 homozygotes received significantly less ephedrine (18 +/- 14 mg) than Arg16 homozygotes (28 +/- 13 mg) and Arg16Gly heterozygotes (30 +/- 20 mg; P = 0.0005). Glu27 homozygotes required significantly less ephedrine than Gln 27 homozygotes (14 +/- 13 vs. 30 +/- 19 mg; P = 0.002). Gln27Glu heterozygotes received less ephedrine than Gln27 homozygotes (23 +/- 16 vs. 30 +/- 19 mg; P = 0.03). Conclusions Glycine at position 16 and/or glutamate at position 27 of the beta2AR leads to lower vasopressor use for treatment of hypotension during spinal anesthesia.

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