Join now to get access to this content and more.
Become a SOAP member and have access to our benefits.
- 2020 SOAP Virtual Meeting Series Videos
- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients
- Sample Centers of Excellence Applications
- ASA Corner
- SOAP Policy and Procedure Manual (P&P Manual)
- SOAP Expert Opinions
- SOAP's Learning Modules
- 2019 Annual Meeting Lecture Videos
- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar
- Submit a Position
- View Job Postings
- Previous Meeting Archives
- Previous Meeting Abstract Search
- CMS Guidelines
- Member Benefits
- Newsletter Clinical Articles
- ACOG Documents
- Search our Patient Safety Archive
- Ask SOAP a Question
- Global Health Opportunities
- And more…
Personalized Hemodynamics: A Statistical Model Predicting The Changes In Maternal Systolic Blood Pressure After Spinal Anesthesia for Cesarean Delivery
Abstract Number: T2B-496
Abstract Type: Original Research
Introduction: Maternal hypotension after spinal anesthesia can pose significant risk for both the mother: lightheadedness, nausea, ultimately, end-organ hypoperfusion; and the fetus: acidosis, hypoxia, and low APGAR scores. Prophylactic vasopressor administration may result in under- or over-treatment of maternal systolic blood pressure (SBP) and present risk for both mother and baby safety. There is little evidence-based guidance about the administration of vasopressors due to the challenges of predicting the maternal SBP course after the onset of spinal anesthesia. The aim of this study is to create a statistical model to prognosticate the next SBP in pregnant women undergoing cesarean delivery under spinal anesthesia.
Methods: We included healthy patients who had cesarean delivery under spinal anesthesia and excluded any patients with history of hypertension, preeclampsia, baseline SBP<90mmHg or incomplete records. We used the vital signs and vasopressor doses from intraoperative records in the 5 minutes before and after spinal anesthesia. A linear mixed-effects model with a gaussian random intercept was used to estimate the association of the following fixed effects with change in SBP from baseline at the next minute: age, BMI, mean baseline SBP, mean baseline HR, amount of bupivacaine, current SBP change from baseline, and current cumulative vasopressor dose. Model fit was assessed by calculating the marginal pseudo-R2 (the variance explained by fixed effects) and conditional pseudo-R2 (the variance explained by entire model) for generalized mixed-effect models.
Results: We used 386 high quality patient records. The average age was 34.34.6 years and the average BMI was 30.45.6 kg/m2. The mean baseline SBP was 128.7 13.3 mmHg and the mean baseline HR was 92.714.7 bpm. Using linear mixed effects model (Table 1), we found that a change in SBP from baseline at the current timepoint explains 65.9% of the variability in change in SBP from baseline at the next timepoint.
Conclusion: We created a predictive model of the changes in maternal SBP after spinal anesthesia. Our next steps will be to determine the corresponding amounts of vasopressor needed to maintain normal SBP. These results will help refine vasopressor administration and tailor the dose to the particular patient, which will ultimately increase the safety of both mother and baby.