Detection of hypotension during spinal anesthesia for caesarean section with continuous non-invasive arterial pressure monitoring and intermittent oscillometric blood pressure monitoring in patients treated with ephedrine or phenylephrine

Abstract

Introduction/Objective. Despite frequent side effects such as hypotension, spinal anesthesia (SA) is still one of the best anesthetic methods for elective cesarean section (CS). Intermittent, oscillometric, non-invasive blood pressure monitoring (NIBP) frequently leads to the missed hypotensive episodes. Our goal was to compare continuous non-invasive arterial pressure (CNAP) monitoring with NIBP in the terms of efficiency to detect hypotension. Methods. In this study, we compared CNAP and NIBP monitoring for hypotension detection in 76 patients divided into two groups of 38 patients treated with ephedrine (E) or phenylephrine (P), during 3 min intervals, starting from SA, by the end of the surgery. Results. In group E, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. CNAP detected 31 (81.6%) hypotensive patients in E group and significantly lower number 20 (52.6%) with NIBP (p = 0.001), while in P group CNAP detected 34 patients (89.5%) and NIBP, only 18 (47.3%), p = 0.001. CNAP detected significantly higher number of hypotensive intervals in E and P groups (p < 0.001). Umbilical vein pH was lower within hypotensive compared with normotensive patients in E and P groups, with CNAP and NIBP, respectively (p < 0.001, p = 0.027 in E, and p = 0.009, p < 0.001, in P group). Conclusion. CNAP is much more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome.