Dataset Information

Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study.

ABSTRACT:

Background

Left uterine displacement (LUD) has been questioned as an effective strategy to prevent aortocaval compression after spinal anesthesia (SA) for cesarean delivery (CD). We tested if LUD has a significant impact on cardiac output (CO) in patients undergoing CD under SA during continuous non-invasive hemodynamic monitoring with Clearsight.

Methods

Forty-six patients were included in the final analysis. We considered 4 timepoints of 5 min each: T1 = baseline with LUD; T2 = baseline without LUD; T3 = after SA with LUD; T4 = after SA without LUD. LUD was then repositioned for CD. The primary outcome was to assess if CO decreased from T3 to T4 of at least 1.0 L/min. We also compared CO between T1 and T2 and other hemodynamic variables: mean, systolic and diastolic blood pressure (respectively MAP, SAP and DAP), heart rate (HR), stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), contractility (dP/dt), dynamic arterial elastance (Ea_dyn) at the different timepoints. Data on fetal Apgar scores and umbilical arterial and venous pH were collected.

Results

CO did not vary from T3 to T4 (CO mean difference -0.02 L/min [95% CI -0.88 to 0.82; P = 1). No significant variation was registered for any variable at any timepoint.

Conclusions

LUD did not show a significant impact on CO during continuous hemodynamic monitoring after SA for CD.

Trial registration

(retrospectively registered on 03/12/2021) NCT05143684 .

SUBMITTER: Sonnino C

PROVIDER: S-EPMC8996426 | biostudies-literature | 2022 Apr

REPOSITORIES: biostudies-literature

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Publications

Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study.

Sonnino Chiara C Frassanito Luciano L Piersanti Alessandra A Giuri Pietro Paolo PP Zanfini Bruno Antonio BA Catarci Stefano S Draisci Gaetano G

BMC anesthesiology 20220411 1

<h4>Background</h4>Left uterine displacement (LUD) has been questioned as an effective strategy to prevent aortocaval compression after spinal anesthesia (SA) for cesarean delivery (CD). We tested if LUD has a significant impact on cardiac output (CO) in patients undergoing CD under SA during continuous non-invasive hemodynamic monitoring with Clearsight.<h4>Methods</h4>Forty-six patients were included in the final analysis. We considered 4 timepoints of 5 min each: T1 = baseline with LUD; T2 = ...[more]

PMID: 35410115

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Project description:ObjectivesWe have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery.DesignProspective cohort study.SettingTertiary hospital in Norway.Participants76 healthy women with uneventful pregnancies undergoing an elective caesarean section.InterventionsWe induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion.Primary and secondary outcome measuresPrimary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery.ResultsMedian age at delivery was 34.5 (range 21-43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56-7.54) L/min before spinal anaesthesia and 6.40 (5.83-7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1-142.7) mm Hg to 134.1 (124.0-146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001).ConclusionsMaternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia.Trial registration numberNCT00977769.

Project description:BackgroundPreoperative anesthesia evaluation is beginning of all anesthesia care. It enables the anesthetists to know general health status of parturient, choose of anesthesia options and discuss the possible complication regarding perioperative anesthesia care. It also creates chance for parturient to know the anesthetist, about anesthesia type as well as possible anesthesia care related complications.ObjectiveTo assess maternal satisfaction with the practice of preoperative anesthesia evaluation among patients underwent elective cesarean delivery.MethodsThis study was a cross-sectional study design conducted from March 1to April 30, 2021. All consecutive parturient that were scheduled for elective cesarean delivery under anesthesia during the study period were interviewed postoperatively after 24 h using semi structure questioner. A checklists, which developed based on the hospital's anesthetic evaluation sheet and Royal Collage of Anesthetist standards (RCOA) were used for data collection. Data were entered in SPSS version 20 and both descriptive and analytic statics analysis were performed.ResultA total of 157 elective patients undergoing elective cesarean section were included with response rate of 96.9%. All patients (100%) were evaluated in the preoperative period. However, 53(33.8%) of patients were receiving information regarding postoperative nausea and vomiting during the preoperative period compared to the standards. Educational level of the anesthetist, fasting instruction, information regarding PONV and information regarding type of anesthesia were significantly associated with overall maternal satisfaction to current practice of preoperative anesthesia evaluation.Conclusion and recommendationThe practice of delivering important information's to parturient during the preoperative anesthesia evaluation was low compared to the standard. Therefore, we recommend anesthesia professionals to give detail explanation regarding the post-operative pain management option, possible inevitable complications and proper rapport with the clients.

Project description:Background: Obesity, abdominal surgery, and intrathecal opioids are all factors associated with a risk for respiratory compromise. The aim of this explorative trial was to study the apnoea/hypopnea index 1st postoperative night in obese mothers having had caesarean section (CS) in spinal anaesthesia with a combination of bupivacaine/morphine and fentanyl. Methods: Consecutive obese (BMI >30 kg/m 2) mothers, ≥18 years, scheduled for CS with bupivacaine/morphine/fentanyl spinal anaesthesia were monitored with a portable polygraphy device Embletta /NOX on 1 st postoperative night. The apnoea/hypopnea index (AHI) was identified by clinical algorithm and assessed in accordance to general guidelines; number of apnoea/hypopnea episodes per hour: <5 "normal", ≥5 and <15 mild sleep apnoea, ≥15 and <30 moderate sleep apnoea, ≥ 30 severe sleep apnoea. Oxygen desaturation events were in similar manner calculated per hour as oxygen desaturation index (ODI). Results: Forty mothers were invited to participate: 27 consented, 23 were included, but polysomnography registration failed in 3. Among the 20 mothers studied: 11 had an AHI <5 ( normal), 7 mothers had AHI ≥5 but <15 ( mild OSAS) and 2 mothers had AHI ≥15 ( moderate OSA), none had an AHI ≥ 30. The ODI was on average 4.4, and eight patients had an ODI >5. Mothers with a high AHI (15.3 and 18.2) did not show high ODI. Mean saturation was 94% (91-96%), and four mothers had mean SpO 2 90-94%, none had a mean SpO2 <90%. Conclusion: Respiratory polygraphy 1 st night after caesarean section in spinal anaesthesia with morphine in moderately obese mothers showed AHIs that in sleep medicine terms are considered normal, mild and moderate. Obstructive events and episodes of desaturation were commonly not synchronised. Further studies looking at preoperative screening for sleep apnoea in obese mothers are warranted but early postop respiratory polygraphy recording is cumbersome and provided sparse important information.

Dataset Information

Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study.

Background

Methods

Results

Conclusions

Trial registration

Publications

Impact of maternal lateral tilt on cardiac output during caesarean section under spinal anaesthesia: a prospective observational study.

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