Perioperative noninvasive cardiac output monitoring in parturients undergoing cesarean delivery with spinal anesthesia and prophylactic phenylephrine drip: a prospective observational cohort study

Orbach‐Zinger, Sharon; Bizman, Ilya; Firman, Shimon; Lev, Shaul; Gat, Roi; Ashwal‏, Eran; Vaturi, Mordehay; Razinski, Eitan; Davis, Atara; Shmueli, Anat; Eidelman, Leonid A.

doi:10.1080/14767058.2018.1458835

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…Phenylephrine is known to cause a dose-dependent decrease in cardiac output. 19 In a previous study performed in our institution, measuring cardiac output at different time points during CD performed under spinal anesthesia with a prophylactic phenylephrine infusion, the pattern of changes in stroke volume at different time points corresponded to the changes in mean frontal lobe ScO 2 seen in the current study. 19 In the study comparing ephedrine and phenylephrine boluses, phenylephrine decreased cardiac output while ephedrine maintained it; and there Cerebral hypoperfusion threshold = absolute decrease of cerebral saturation <50% or decrease more than 20% from baseline.…”

Section: Discussionsupporting

confidence: 71%

A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension

Kornilov

Orbach‐Zinger

Hoshen

et al. 2019

International Journal of Obstetric Anesthesia

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Background: Spinal hypotension causes decreased regional cerebral oxygen saturation (ScO 2 ) in women undergoing cesarean delivery. In this study we aimed to measure the change in ScO 2 using near infrared spectroscopy in women receiving a prophylactic phenylephrine infusion during cesarean delivery under spinal anesthesia. Methods: This was a prospective, observational cohort study. Fifty-three women had ScO 2 measurements at the following time points: preoperatively, in the supine position with 30°of left lateral tilt; one and five minutes after spinal anesthesia; at the time of skin incision; immediately after delivery; one minute after commencing the oxytocin infusion; at completion of surgery, and one hour after surgery. Spinal anesthesia and a prophylactic phenylephrine infusion were administered according to a standard treatment protocol. Statistical analysis used the Wilcoxon Signed Rank test with Bonferroni's correction for multiple comparisons. Results: Blood pressure was maintained within 20% of baseline throughout surgery. The baseline mean (range) ScO 2 was 61.5% (54.0-66.3%). It decreased significantly at all subsequent measurement points. The maximum decrease was five minutes after spinal anesthesia. Thirty-four (64.2%) of the parturients exhibited ScO 2 values <20% of baseline, or a decrease to below an absolute value of 50%. There was no significant correlation between systolic blood pressure and mean ScO 2 . Conclusion: Spinal anesthesia with phenylephrine infusion during cesarean delivery is associated with a significant decrease in ScO 2 levels, maximal five minutes later. Further studies are required to establish the clinical significance of this finding.

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Section: Discussionsupporting

confidence: 71%

A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension

Kornilov

Orbach‐Zinger

Hoshen

et al. 2019

International Journal of Obstetric Anesthesia

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“…CO and SVR changes after spinal anesthesia are still controversial. Previous studies have reported that CO increases significantly immediately after spinal anesthesia, followed by a significant reduction in CO subsequent to the administration of vasoconstriction drugs (15,16). A rapid and profound reduction in SVR after spinal anesthesia often precedes the reduction in MAP (17).…”

Section: Discussionmentioning

confidence: 95%

Continuous cardiovascular hemodynamics monitoring with pressure recording analytical method in patients under spinal anesthesia for elective cesarean section: a pilot study

Zhang¹,

Xu²,

Jia³

et al. 2021

Ann Palliat Med

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Background: Pressure recording analytical method (PRAM) of MOSTCARE is a minimally invasive system based on mathematical analysis of arterial pressure profile changes and allows continuous recording of hemodynamic measurements. Herein, we aimed to use the MostCare system to investigate the hemodynamics of patients receiving spinal anesthesia during elective cesarean section.Methods: In this observational study, we recruited 17 patients scheduled for elective cesarean section.For each patient, we acquired continuous recordings of hemodynamic parameters at 14 key timepoints: surgical admission (two baseline parameters), immediately after the administration of spinal anesthesia, six subsequent time points (2, 4, 6, 8, 10, and 12 min after anesthesia), during peritoneum and uterine incision, during delivery, following the administration of oxytocin, and after surgery had been completed. Statistical analysis was carried out by repeated measures analysis of variance (ANOVA).Results: During a twelve min period after spinal anesthesia, we observed significant reductions in mean arterial pressure (MAP), dicrotic pressure (Pdic), cardiac index (CI), stroke volume index (SVI), dP/dt max , and cardiac cycle efficiency (CCE) (P<0.05 for all). However, systemic vascular resistance index (SVRI) was reversely correlated to CI and increased significantly after spinal anesthesia (P<0.05). These hemodynamic parameters return to near basal values after peritoneum incision. Furthermore, there were significant fluctuations in MAP, Pdic and CI after oxytocin administration (P<0.05).Conclusions: PRAM of MostCare system revealed significant changes in key hemodynamic parameters undergoing cesarean section with spinal anesthesia. It enables clinicians gain a much better understanding of hemodynamics of parturients and optimize clinical management strategies.

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“…Частота развития артериальной гипотонии у беременных в ходе применения нейроаксиальных методов обезболивания может составлять от 80-90 % [22][23][24][25]. Механизм развития данного осложнения связан непосредственно с артериальной дилатацией и снижением системного сосудистого кровотока, что первоначально обусловлено развитием симпатической блокады.…”

Section: Impact Of Anesttesia Methods On Foetus Conditionunclassified

Impact of anesttesia method on foetus condition

Морозов

Pichugova

Аскеров

et al. 2021

vmirvz

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Topicality. Currently, intrapartum fetal health care is aimed at an adequate choice of anesthetic aid used during delivery to minimize the negative impact. Despite the wide range of currently existing anesthetics, the choice of anesthetic drug is limited by its negative effect not only on the fetus, but also on the contractile activity of the uterus, which significantly reduces the number of anesthetics used in obstetric practice.The purpose of this study is to analyze domestic and foreign literature in order to study the effect of anesthesia on the condition of the fetus. Material and methods. In the course of this study, an analysis of modern Russian and foreign literary sources, as well as the latest scientific works in the field of methods of general and regional anesthesia in the field of obstetrics and gynecology, was carried out.Results. Almost all drugs used for general anesthesia in obstetric practice can have a negative effect on the fetus. Neuroaxial pain relief methods are leading in obstetric practice, but their use is associated with complications that can lead to an adverse outcome not only from the mother, but also from the fetus. One such complication is the risk of arterial hypotension. It is interesting that comparative studies of general and regional anesthesia methods during operative delivery differ in the results obtained. Regarding the issue of anesthesia of natural births, the information of the Congress of the American Society of Anesthesiologists (lecture C.A. Wong (Chicago) “Neuroaxial Labor Analgesia and Prognancy Outcome: Factand Fiction”) remains relevant, according to which neuroaxial anesthesia methods do not affect the condition of the fetus, provided that the mother has stable hemodynamics.Conclusion. Due to the appearance and release of neuroaxial pain relief methods, completely unreasonably little attention is paid to the issues of general anesthesia of pregnant women, while according to the results of a study of scientific literary sources, it was revealed that this method of pain relief in obstetric practice is accompanied by the most direct and mediated effects on the fetus. Neuroaxial pain relief methods have practically no effect on the condition of the fetus, provided that the mother has stable hemodynamics.

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Perioperative noninvasive cardiac output monitoring in parturients undergoing cesarean delivery with spinal anesthesia and prophylactic phenylephrine drip: a prospective observational cohort study

Cited by 11 publications

References 20 publications

A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension

A prospective observational study of the change in regional cerebral oxygen saturation during cesarean delivery in women receiving phenylephrine prophylaxis for spinal hypotension

Continuous cardiovascular hemodynamics monitoring with pressure recording analytical method in patients under spinal anesthesia for elective cesarean section: a pilot study

Impact of anesttesia method on foetus condition

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