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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

The incidence of non-invasive blood pressure measurement failure, as a result of shivering, during delivery in the operating room: an audit

Abstract Number: S 1
Abstract Type: Original Research

ILANA SEBBAG M.D.1 ; SIMON MASSEY MD2; SEAN B MCCURDY -3; SUSAN BRIGHT MD4; DANIELLE MURRAY B.Sc.5; JOANNE DOUGLAS MD6

Introduction

Shivering related to spinals, epidurals or combined spinal-epidurals is common in pregnant women delivering via operative delivery (caesarean or forceps). Shivering can affect non-invasive blood pressure (NIBP) monitoring on the patient’s upper arm to the extent that blood pressure measurements cannot be recorded. Investigating the incidence of NIBP failure as a result of shivering will help anesthesiologists learn more about this problem, and facilitate the design of a future project addressing this important concern. This prospective audit collected data about the incidence of failed (NIBP) as a result of maternal shivering during their operative delivery. Informed consent was waived due to the nature of the study and ethics committee approval was obtained.

Material and Methods

Over four weeks, anesthesiologists recorded the occurrence of NIBP failure and shivering during operative deliveries (forceps and/or caesarean deliveries) through a data collection sheet. All deliveries taking place in the OR during this period of time were included. The only exclusion criterion was the use of arterial line to monitor blood pressure.

Results

One hundred and ninety patients were included, contributing to a high capture rate of 97% (total OR deliveries=196). Overall incidence of shivering was 51%. The majority of shivering patients were the ones that had a functioning labour epidural and received an epidural top-up for forceps or cesarean delivery (63.4%). Incidence of shivering on epidural patients was as high as 83%. Failure due to this shivering occurred in 38% of epidural patients. On the other hand, spinal anesthesia patients shivered in only 29% of the cases, and NIBP failure due to shivering occurred in 9% of the spinal patients.

Conclusion

The results show significant occurrence of NIBP failure, predominantly in epidural anaesthesia. We have documented a critical issue affecting the standard of care for NIBP monitoring. Future studies should address how to reduce the incidence of NIBP measurement failure.

References

Thermoregulatory effects of spinal and epidural anesthesia during cesarean delivery. Saito T et al. Reg Anesth Pain Med 1998;23:418-23

Shivering and neuraxial anesthesia. Crowley L J, Buggy D J Reg Anesth Pain Med 2008;33:241-252

Incidence of failure of upper limb automated blood pressure measurement during caesarean section. M Hamad, R Freeman, I Wrench PD06 IJOA 2001;10:218



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