Continuous haemodynamic effects of left tilting and supine positions during Caesarean section under spinal anaesthesia with a noninvasive cardiac output monitor system

Jiang

2019

Preprint

Background Maternal cardiac arrest during cesarean section (CS) is an extremely rare but devastating complication. Preventing emergency events from developing into maternal cardiac arrest is one of the most challenging clinical scenarios. Case presentation A 35-year-old pregnant woman with subvalvular aortic stenosis who was scheduled for elective CS under epidural anesthesia, and experienced devastating supine hypotensive syndrome, but was successfully resuscitated after delivery. Conclusions The performance of tilt position strictly or high-quality continue manual left uterine displacement (LUD) should be performed until the fetus is delivered, otherwise timely delivery of the fetus may be the best way to optimize the deadly condition.

Section: Discussionmentioning

confidence: 58%

Aortocaval compression resulting in sudden loss of consciousness and severe bradycardia and hypotension during cesarean section in a patient with subvalvular aortic stenosis

Jiang

2019

Preprint

“…In clinical practice, obstetricians often prefer tend to apply a lesser degree of left tilt or even supine position because of subjective feeling of insecurity' for parturients and very less convenient to perform CS. Although the cardiac output (CO) between with and without tilt at CS has no significant difference in noncardiac patient [4][5][6] , and not lead to deadly outcomes for women with normal pregnancy, but may result in devastating outcomes for pregnancy women with LVOT obstruction, as demonstrated the patient with SAS in our case.…”

Section: Discussionmentioning

confidence: 58%

Aortocaval compression resulting in sudden loss of consciousness and severe bradycardia and hypotension during cesarean section in a patient with subvalvular aortic stenosis

Jiang

2019

Preprint

Background: Maternal cardiac arrest during cesarean section (CS) is an extremely rare but devastating complication. Preventing emergency events from developing into maternal cardiac arrest is one of the most challenging clinical scenarios. Case presentation: A 35-year-old pregnant woman with subvalvular aortic stenosis (SAS) who was scheduled for elective CS under epidural anesthesia, and experienced devastating supine hypotensive syndrome, but was successfully resuscitated after delivery. Conclusions: The performance of tilt position strictly or high-quality continue manual left uterine displacement (LUD) should be performed until the fetus is delivered, otherwise timely delivery of the fetus may be the best way to optimize the deadly condition. Keywords: Subvalvular aortic stenosis, Pregnancy, Cesarean section, Hypotension.

“…Moreover, a higher incidence of hypotension occurred in obese parturients during neuraxial anaesthesia, which partly contributed to vascular compression by hypertrophic uterus (Nani and Torres, 2011). Yet, a recent study declared that the hemodynamic parameters derived from a noninvasive cardiac output monitoring system were not statistically different between the left-tilt and supine position (Tsai, Yeh et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Incidence and Associated Factors for Neuraxial Anaesthesia-Related Hypotension in COVID-19 Parturients Undergoing Caesarean Delivery: A Multicenter Case-Control Study

Zhang

Cao

et al. 2021

Preprint

Background: COVID-19 continues to spread globally and results in additional challenges for perioperative management in parturients. The purpose of this study was to determine the incidence and identify associated factors for neuraxial anaesthesia-related hypotension in COVDI-19 parturients during caesarean delivery.Methods: We performed a multicenter case-control study at 3 medical institutions in Hubei province, China form 1th January to 30th May 2020. All ASA Physical Status II full termed pregnant women who received caesarean delivery under neuraxial anaesthesia were eligible for inclusion. The univariate analysis and binary logistic regression analysis were used to identified the independent predictors of neuraxial anaesthesia-related hypotension.Results: Present study included 102 COVID-19 parturients. The incidence of neuraxial anaesthesia-related hypotension was 58%. Maternal abnormal lymphocyte count (OR = 3.41, p = 0.03), full stomach (OR = 3.22, p = 0.04), baseline heart rate (OR = 1.04, p = 0.03), experience of anaesthetist (OR = 0.86, p = 0.02) and surgeon (OR = 0.76, p = 0.03), and combined spinal-epidural anaesthesia technique (OR = 3.27, p = 0.02) were associated with neuraxial anaesthesia-related hypotension. The area under the receiver operating characteristic curve achieved 0.83 which was significantly higher than 0.5 (p < 0.001). And the sensitivity, specificity and percentage correct were 75%, 79% and 75%, respectively. The Hosmer-Lemeshow test showed a good calibration of the model (H = 2.01, DF = 8, p = 0.98).Conclusions: Maternal abnormal lymphocyte count, full stomach, baseline heart rate, experience of anaesthetist and surgeon, and combined spinal-epidural anaesthesia technique were identified as the independent predictors of neuraxial anaesthesia-related hypotension.