Maternal Cardiovascular Dynamics. I. Cesarean Section Under Subarachnoid Block Anesthesia

Ueland, Kent; Gills, Raymond E.; Hansen, John M.; Wyant, Gordon M.

doi:10.1097/00132586-196902000-00044

Cited by 18 publications

(24 citation statements)

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“…In the normotensive group, the 95% limits of agreement was -14.95 to 10.77 bpm, and the mean bias was -2.09 bpm for HR, -32.77 to 37.93 ml and 2.58 ml for SV, -2.74 to 2.83 l/min and 0.04 l/min for CO, -1.68 to 1.52 l/min/m 2 and -0.08 l/min/m 2 for CI and -771.0 to 606.0 dyn×s×cm 5 and -83.0 dyn×s×cm 5 for TPR, respectively. In the pregnancies complicated by hypertensive disorders, the 95% limits of agreement was -16 to 12 bpm, with a mean bias of -2 bpm for HR, -31 to 30 ml and 0.2 ml for SV, -2.96 to 2.54 l/min and -0.2 l/min for CO, -1.8 to 1.28 l/min/m 2 and -0.26 l/min/m 2 for CI and -688 to 652 dyn×s×cm 5 and -18 dyn×s×cm 5 for TPR, respectively. The MPD was <30% for HR estimation, while it was >30% for the estimation of SV, CO, CI and TPR.…”

Section: Resultsmentioning

confidence: 98%

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Non-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance

et al. 2016

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Background: Due to the importance of cardiovascular dysfunction and advances in the development and use of non-invasive cardiac output (CO) monitoring devices, there is a growing interest in their use in the obstetric population. The aim of this study was to compare two commercially available, non-invasive CO monitors in the assessment of heart rate (HR), stroke volume (SV), CO, cardiac index (CI) and total peripheral resistance (TPR) in an obstetric population. Methods: This was a prospective, comparative study including two groups. A normotensive group, which consisted of uncomplicated healthy pregnancies, and a hypertensive group, which consisted of those complicated by hypertensive disorders of pregnancy. Non-invasive cardiovascular assessments were performed using two methodologies. USCOM® is an operator-dependent Doppler ultrasound device which obtains velocity time integrals of transaortic blood flow at the left ventricular outflow tract, while NICOM® provides an operator-independent haemodynamic profile by assessing thoracic voltage changes (bioreactance) which reflect pulsatile blood flow in the thorax. Correlation coefficients were derived, and Bland-Altman analysis was performed to derive the mean percentage difference (MPD) between the devices. Results: 598 women were recruited for this study. In the normotensive group, 524 paired results were analysed, while 74 paired results were analysed in the hypertensive group. In the normotensive group, we found excellent correlation between USCOM® and NICOM® for HR (r = 0.885, p < 0.05), and moderate correlations for SV (r = 0.445, p < 0.05), CO (r = 0.529, p < 0.05), CI (r = 0.385, p < 0.05) and TPR (r = 0.524, p < 0.05). In the hypertensive group, we obtained similar correlations (HR: r = 0.877, p < 0.05; SV: r = 0.575, p < 0.05; CO: r = 0.601, p < 0.05; TPR: r = 0.589, p < 0.05). Bland-Altman analysis found that the agreement between both methodologies improved as gestation advances, with an MPD of 34% for CO estimation in the third trimester of uncomplicated pregnancies, and 39% in pregnancies complicated by hypertensive disorders. Conclusion: Our findings suggest that the two methodologies perform similarly in both uncomplicated pregnancies and in pregnancies complicated by hypertensive disorders. The study findings do not preclude the use of USCOM® and NICOM® devices in pregnancy, but indicate that these platforms cannot be used interchangeably. Our findings demonstrate an improvement in MPD as gestation advances and, therefore, questions the validity of previous longitudinal studies investigating maternal haemodynamics using these methodologies. Our work also highlights the need to construct reference ranges for each device and for validation of each methodology against a reference method before their use in research or clinical practice.

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Section: Resultsmentioning

confidence: 98%

“…In previous decades, changes in maternal haemodynamics were investigated using dye dilution techniques and pulmonary artery catheterization (PAC) [4,5] . CO measurement with a PAC using the bolus thermodilution method has been considered as the gold standard [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance

et al. 2016

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“…Using a dye dilution technique, Ueland et al demonstrated a 35% decrease in CO when a spinal anesthetic was performed (tetracaine 7-10 mg with epinephrine 200 mcg) without prehydration, and the pregnant patient placed in the supine position [66]. By contrast, utilizing the beat-to-beat CO measurements provided by bioimpedance, Tihtonen et al observed an immediate 11% increase in CO when 10 ml/kg colloid prehydration was given, hyperbaric bupivacaine 12-13.5 mg was administered, the patient was positioned in left uterine displacement, and a mean ephedrine dose of 0.53 mg/kg was provided [40].…”

Section: Contribution Of Cardiac Output Variabilitymentioning

confidence: 99%

“…These hemodynamic alterations are believed to exist for approximately 10 min [40] prior to resolution to predelivery values. The increase in CO at the time of fetal delivery varies significantly, with a range of less than 10% [98], to as much as 61% (from baseline) and 140% (from post-block values) [66]. The latter values were originated in a study where uterine displacement was not used, likely exaggerating the removal of uterine aortocaval compression upon delivery.…”

Section: Delivery Of the Fetusmentioning

confidence: 99%

Cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia

Arendt

Muehlschlegel

Tsen

2012

Expert Review of Obstetrics & Gynecology

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During cesarean delivery with neuraxial anesthesia, maternal hemodynamic changes occur with prehydration of intravenous fluid, block onset and delivery of the fetus. The direction and degree of these hemodynamic changes is influenced by multiple interacting variables including the physiologic and anatomic alterations of pregnancy, maternal and fetal characteristics, comorbid conditions, the neuraxial technique, the amount of blood loss and fluid and drug administration. In this review, the influences of each of these variables, as well as the techniques used to evaluate, prevent and treat hypotension, are discussed to provide a comprehensive overview of the cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia.

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“…More than 40 years ago maternal haemodynamic changes during spinal anaesthesia for caesarean section were investigated using dye dilution techniques. 1 Pulmonary artery catheterisation has since been widely used to investigate haemodynamic changes in both the healthy parturient and those with hypertensive disorders or critical illness. [2][3][4] Invasive haemodynamic monitoring may no longer be desirable in the management of the parturient due to the potential risk of complications and issues with patient compliance.…”

Section: Introductionmentioning

confidence: 99%

Minimally- and non-invasive assessment of maternal cardiac output: go with the flow!

Armstrong¹,

Fernando²,

Columb³

2011

International Journal of Obstetric Anesthesia

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Maternal Cardiovascular Dynamics. I. Cesarean Section Under Subarachnoid Block Anesthesia

Cited by 18 publications

References 0 publications

Non-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance

Non-Invasive Haemodynamic Monitoring in Pregnancy: A Comparative Study Using Ultrasound and Bioreactance

Cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia

Minimally- and non-invasive assessment of maternal cardiac output: go with the flow!

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