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Use of Transthoracic Echocardiography to Assess Hemodynamic Changes Associated with CSE Labor Analgesia
Abstract Number: T-67
Abstract Type: Original Research
Background: Point-of-care (POC), focused cardiac ultrasound is being integrated into a variety of acute care settings, including obstetric anesthesia, to guide clinical decision making.1 However, it is unclear whether image acquisition is feasible and measurements are valid in the dynamic environment of labor. The aim of this pilot study was to determine the feasibility of using POC, focused cardiac ultrasound in laboring patients to evaluate left ventricular and IVC volume status before and after CSE labor analgesia.
Methods: After IRB approval and written informed consent, 10 healthy parturients admitted for elective labor induction were recruited. Ultrasound was used [Sonosite M Turbo, P-21x/5-1 mHz transducer] to measure left ventricular end-diastolic diameter (LVEDD) and inferior vena cava diameter (ICVD) during three different time periods: prior to oxytocin induction (Baseline), at request for analgesia (Pre-CSE), and 10 minutes after IT administration (Post-CSE). Neuraxial analgesia was initiated using a CSE technique (IT bupivacaine 2.5 mg, fentanyl 15 mcg, followed by epidural test dose [lidocaine 45 mg, epinephrine 15 mcg]). A crystalloid bolus (LR 500 mL) was co-administered with CSE. Images were acquired from parasternal short axis (PSSA), parasternal long axis (PSLA), and subcostal (SC) views, by a single investigator (ED), with patients in the left lateral decubitus position. Three measurements were made for PSSA and PSLA views at each time period; two measurements were made for ICVD at end-expiration (EXP) and end-inspiration (INSP). Data were compared over time and between modalities using a repeated measures generalized linear model.
Results: [Table] Image acquisition was obtained in 100% of PSSA and PSLA attempts, and 90% of SC exams. The coefficient of variance for mean LVEDD measurements was 6% for PSSA and 5% for PSLA views. No patient required vasopressor post-CSE.
Conclusions: It is feasible to obtain PSSA, PSLA and IVC images with reproducible measurements in laboring patients. No significant changes were observed in LVEDD or IVCD over time despite decreases in BP post-CSE. This methodology may be used to assist clinical decision-making in laboring parturients.
1. Dennis, A. Use of Transthoracic Echocardiography in Postpartum Hypotension. Anesth Analg 2012;115:1033-7