Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000300007
Brazilian Journal of Anesthesiology
Scientific Article

Monitoramento não invasivo baseado na biorreatância revela instabilidade hemodinâmica significativa durante cesárea eletiva sob raquianestesia

Non-invasive monitoring based on bioreactance reveals significant hemodynamic instability during elective cesarean delivery under spinal anesthesia

Anne Doherty; Yayoi Ohashi; Kristi Downey; Jose CA Carvalho

http://dx.doi.org/10.1590/S0034-70942011000300007 Braz J Anesthesiol, vol.61, n3, p.326-332, 2011
PDF Português
PDF English
Downloads: 0
Views: 986

Resumo

JUSTIFICATIVA E OBJETIVOS: O monitoramento da pressão arterial oferece uma compreensão limitada das consequências hemodinâmicas da raquianestesia para cesariana. O objetivo deste estudo foi avaliar, com o auxílio do monitor de débito cardíaco não invasivo baseado na biorreatância, as alterações hemodinâmicas durante cesariana eletiva sob raquianestesia, na qual doses intermitentes de fenilefrina foram utilizados para prevenir e tratar a hipotensão. MÉTODOS: Este estudo observacional foi realizado após aprovação da comissão de ética na pesquisa e assinatura do consentimento informado. Pacientes saudáveis marcadas para cesariana eletiva sob raquianestesia foram avaliadas. Doses intermitentes de fenilefrina foram administrados para manter a pressão arterial sistólica nos níveis basais e as pacientes foram avaliadas com o monitor de débito cardíaco não invasivo baseado na biorreatância. Os dados hemodinâmicos foram colhidos continuamente no momento basal e durante os períodos pós-raquianestesia e pós-nascimento do feto. Os dados foram analisados usando ANOVA para modelos mistos e um p < 0,05 foi considerado significativo. RESULTADOS: A pressão arterial sistólica foi mantida entre 79,2% ± 14,2 e 105,9% ± 10,0 dos valores basais durante o período pós-raquianestesia e 78,4% ± 11,13 e 100,9% ± 10,7 dos valores basais no período pós-nascimento do feto (média ± DP). Flutuações significativas foram observadas na pressão arterial sistólica, frequência cardíaca e débito cardíaco no período pós-nascimento. CONCLUSÕES: Um novo monitor não invasivo, baseado na biorreatância, revelou flutuações hemodinâmicas significativas durante a cesariana sob raquianestesia, a despeito das tentativas de manter a pressão arterial nos níveis basais com doses intermitentes de fenilefrina.

Palavras-chave

ANESTESIA, Obstétrica, CIRURGIA, Obstétrica, COMPLICAÇÕES, TÉCNICAS DE MEDIÇÃO, Regional

Abstract

BACKGROUND AND OBJECTIVES: Blood pressure monitoring offers a limited understanding of the hemodynamic consequences of spinal anesthesia for cesarean delivery. The purpose of this study was to assess, with the aid of a non-invasive cardiac output monitor based on bioreactance, the hemodynamic changes during elective cesarean delivery under spinal anesthesia in which intermittent boluses of phenylephrine were used to prevent and treat hypotension. METHODS: This observational study was conducted with the Research Ethics Board approval, and all participants provided written informed consent. Healthy patients undergoing elective cesarean delivery under spinal anesthesia were enrolled. Intermittent boluses of phenylephrine were administered in an attempt to maintain systolic blood pressure at baseline levels, and patients were assessed with a non-invasive cardiac output monitor based on bioreactance. Hemodynamic data was collected continuously at baseline, and during the postspinal and postdelivery periods. Data was analyzed using a mixed model ANOVA, and a p < 0.05 was considered significant. RESULTS: Systolic blood pressure was maintained within 79.2 ± 14.2 and 105.8 ± 10.0 percent of baseline during the postspinal period, and 78.4 ± 11.3 and 100.9 ± 10.7 percent of baseline in the postdelivery period (mean ± SD) There were significant fluctuations in systolic blood pressure, heart rate, and cardiac output during the postspinal period, and significant fluctuations in systolic blood pressure and cardiac output in the postdelivery period. CONCLUSIONS: A new non-invasive monitor based on bioreactance reveals significant hemodynamic fluctuations during cesarean delivery under spinal anesthesia, despite attempts to maintain blood pressure at baseline levels with intermittent boluses of phenylephrine.

Keywords

Anesthesia, Obstetrical, Spinal, Cesarean Section, Hemodynamics Monitoring, Bioreactance

References

Clark RB, Thompson DS, Thompson CH. Prevention of spinal hypotension associated with Cesarean section. Anesthesiology. 1976;45:670-674.

Macarthur A, Riley ET. Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin. 2007;45:115-132.

Pinder AJ, Dresner M, Calow C. Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia. Int J Obstet Anesth. 2002;11:156-159.

Langesaeter E, Rosseland LA, Stubhaug A. Hemodynamic effects of oxytocin during cesarean delivery. Int J Gynaecol Obstet. 2006;95:46-47.

Cyna AM, Andrew M, Emmett RS. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006.

Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 2004;92:469-474.

Ngan Kee WD, Khaw KS, Tan PE. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009;111:506-512.

Tihtonen K, Koobi T, Yli-Hankala A. Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand. 2005;84:355-361.

Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus highdose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008;109:856-863.

Keren H, Burkhoff D, Squara P. Evaluation of a noninvasive continuous cardiac output monitoring system based on thoracic bioreactance. Am J Physiol Heart Circ Physiol. 2007;293:H583-H589.

van Oppen AC, Stigter RH, Bruinse HW. Cardiac output in normal pregnancy: a critical review. Obstet Gynecol. 1996;87:310-318.

Dennis A, Arhanghelschi I, Simmons S. Prospective observational study of serial cardiac output by transthoracic echocardiography in healthy pregnant women undergoing elective caesarean delivery. Int J Obstet Anesth. 2010;19:142-148.

Moertl MG, Ulrich D, Pickel KI. Changes in haemodynamic and autonomous nervous system parameters measured non-invasively throughout normal pregnancy. Eur J Obstet Gynecol Reprod Biol. 2009;144(^s1):S179-S183.

Ohashi Y, Ibrahim H, Furtado L. Non-invasive hemodynamic assessment of non-pregnant healthy pregnant and preeclamptic women using bioreactance. Rev Bras Anestesiol. 2010;60:603-613.

Dyer RA, Reed AR, van Dyk D. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009;111:753-765.

Tanaka M, Balki M, Parkes RK. ED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery. Int J Obstet Anesth. 2009;18:125-130.

Gutkowska J, Jankowski M, Mukaddam-Daher S. Oxytocin is a cardiovascular hormone. Braz J Med Biol Res. 2000;33:625-633.

Thibonnier M, Conarty DM, Preston JA. Human vascular endothelial cells express oxytocin receptors. Endocrinology. 1999;140:1301-1309.

Thomas DG, Robson SC, Redfern N. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 1996;76:61-65.

Squara P, Denjean D, Estagnasie P. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med. 2007;33:1191-1194.

5dd6c9970e8825314b13f287 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections