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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Non-invasive hemodynamic monitoring based on bioreactance reveals very diverse hemodynamic profiles during elective Cesarean delivery under spinal anesthesia

Abstract Number: 33
Abstract Type: Original Research

Anne Doherty MD1 ; Yayoi Ohashi MD, PhD2; Kristi Downey MD3; Jose C.A. Carvalho MD, PhD4

Background: Current data supports the maintenance of maternal systolic blood pressure (SBP) at baseline throughout Cesarean delivery under spinal anesthesia (1). Although maternal and neonatal outcomes with this practice seem excellent, it would be ideal to reveal the complete hemodynamic profile of each individual patient. Transthoracic bioreactance is a newer technique of continuous noninvasive cardiac output monitoring (NICOM), and it has not yet been used during Cesarean deliveries (2). The purpose of this study was to use the NICOM to document the hemodynamic changes during elective Cesarean deliveries under our current management.

Methods: This study was conducted with REB approval and written informed consent. We enrolled patients undergoing elective Cesarean delivery under spinal anesthesia. Patients were co-loaded with 10 ml/kg of RL. Spinal anesthesia was performed in the sitting position, at L3-L4, with hyperbaric bupivacaine 0.75% 1.8 ml, 100 g of fentanyl and 10 g of morphine. We aimed at maintaining SBP at 100% of baseline levels with intermittent boluses of phenylephrine 100 g. Patients were monitored with 4 electrodes applied to the thorax, which were connected to a NICOM, in addition to NIBP and SpO2 monitors. Hemodynamic data (CO, SBP, DBP, MAP, HR, SV and TPR) were collected prior to the spinal (control) and continuously throughout the procedure until 10 minutes after delivery of the infant. We studied the mean values and the maximum % variation for each variable during the pre- and post-delivery period.

Results: Twenty patients were studied. The mean values for all hemodynamic variables remained stable during the pre- and post-delivery periods (Table). However, the mean maximum decrease or increase for each variable during the same observation periods showed extremely diverse patterns. The mean maximum decrease in CO in the pre-delivery period was 22.3%.

Discussion: Despite the relative success of our current strategies to maintain blood pressure stability during Cesarean deliveries under spinal anesthesia, the hemodynamic profiles seen in individual patients are extremely varied. Some of these changes are dramatic, and may have implications for patient safety. We suggest that non-invasive cardiac output monitors could be valuable resources not only in research but in the daily practice of obstetric anesthesia.

References: 1. Anaesth 2005; 103:744-50; 2) Am J Physiol Heart Circ Physiol 2007; 293:583-589

SOAP 2010