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Comparative Effectiveness of Lower Leg Compression Devices Versus Sequential Compression Devices to Prevent Post-Spinal Hypotension during Cesarean Delivery.
Abstract Number: T-19
Abstract Type: Original Research
Introduction: Thromboembolic deterrent hose stockings (TEDs) and sequential compression mechanical devices (SCDs) both reduce the incidence of maternal hypotension during cesarean delivery (CD).(1,2) However, the comparative effectiveness of these modalities on preventing post-spinal hypotension has not been investigated. The aim of this retrospective study was to compare the vasopressor requirements and maternal hemodynamics of women who received TEDs vs. SCDs during CD.
Methods: After IRB approval, we reviewed the electronic medical records of a cohort of women undergoing elective CD under spinal anesthesia before and after we changed our departmental protocol from intraoperative TEDs to SCDs. All patients received a spinal anesthetic (12 mg hyperbaric bupivacaine, fentanyl 10 mcg and morphine 200 mcg), and a fluid preload (500 ml 6% hetastarch+1000 ml lactated ringers). Phenylephrine (PE) boluses were administered to treat post-spinal hypotension. Our primary outcomes were: (i) the incidence of PE use within each group, and (ii) the total PE dose given during CD. Secondary outcomes were: maternal hemodynamic indices (HR, SBP, DBP). We used Mann-Whitney test and Chi-squared/Fisher’s tests for continuous and categorical data. Longitudinal analyses of HR, SBP, and DBP were performed using a linear mixed-effects regression model with study group and time as fixed effects. Data presented as median [IQR], n (%); P<0.05 as statistically significant.
Results: We extracted perioperative data on 210 women who used SCDs (n=105) or TEDs (n=105). We found no between-group differences in demographic or obstetric characteristics. Within each group, the incidence of intraoperative PE use was high (SCDs=95% vs. TEDs=94%; P=1.0). The median total dose of intraoperative PE given intraoperatively was similar in both groups (SCDs=300 mg [100-450] vs. TEDs=300 mg [100-450]; P = 0.9). We found no between-group differences in maternal HR, SBP and DBP over time. (Figure)
Discussion: Patients receiving SCDs or TEDs have similar pressor requirements and hemodynamic indices during CD. The very high incidence of intraoperative PE use in both groups provides further evidence to substantiate the limited efficacy of pre-spinal interventions (SCDs or TEDs combined with colloid/crystalloid preload) in preventing spinal hypotension during CD.(3)
(1) Cochrane Review 2006, Issue 4: CD002251
(2) Int J Obstet Anesth. 2012;21:140-5
(3) Anesth Analg. 2010;111:1093-5