Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Kuhn, Jana Christine; Hauge, Tor Hugo; Rosseland, Leiv Arne; Dahl, Vegard; Langesæter, Eldrid

doi:10.1213/ane.0000000000001174

Cited by 51 publications

(39 citation statements)

References 118 publications

(443 reference statements)

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“…The primary effect of spinal anaesthesia in a healthy woman is a decrease in systemic vascular resistance secondary to small artery vasodilation , with a modest degree of venodilation . There is a compensatory baroreceptor‐mediated increase in heart rate and stroke volume, which increases cardiac output .…”

Section: Cardiovascular Changes After Spinal Anaesthesiamentioning

confidence: 99%

“…Other measures to prevent or treat hypotension and haemodynamic instability include methods to reduce inferior vena cava compression and venous pooling in the legs, as well as intravascular fluid loading . Once the woman is positioned supine for surgery, left uterine displacement is routinely used to reduce inferior vena cava compression, with a recommended angle of 15° .…”

Section: Cardiovascular Changes After Spinal Anaesthesiamentioning

confidence: 99%

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International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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Why was this consensus statement developed?Advances in clinical practice are sometimes inhibited by a multitude of different options that need to be selected. There has been significant variation in the treatment of spinal anaesthesia-induced hypotension. These guidelines are designed to provide clinicians with specific best-practice plans that will cover a wide range of drug and equipment availability. Detailed recommendations are provided for the management of hypotension in resource-rich and resource-poor environments.

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Section: Cardiovascular Changes After Spinal Anaesthesiamentioning

confidence: 99%

Section: Cardiovascular Changes After Spinal Anaesthesiamentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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“…Several studies have been performed using invasive and non‐invasive devices during Cesarean section, but none has compared a non‐invasive device to the current clinical standard of monitoring maternal hemodynamic parameters during high‐risk Cesarean section. Furthermore, most published studies have relied on percentage error or difference to evaluate or compare monitors, even though such a comparison is inappropriate when a gold‐standard invasive monitoring method is lacking.…”

Section: Discussionmentioning

confidence: 99%

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

Gutiérrez

Perry

Columb

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal-directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non-invasive (NICOM ® ) devices, and to assess agreement between the two devices in measuring CO.Methods Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland-Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles.Results From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from −1.58 (95% CI, −4.47 to −0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. Conclusions There are large mean differences between CO measurements obtained during Cesarean section usingCorrespondence to: the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage. Copyright

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“…Administration of a rescue bolus was repeated at 1-minute intervals if hypotension persisted. We didn't stop the treatment until hypotension improves or tends to improve [14,15] . Reactive hypertension, defined as an increase in SBP to ≥ 20% above the baseline, was treated by stopping the infusion of methoxamine.…”

Section: Monitoring and Interventionsmentioning

confidence: 99%

A Randomised Dose-Response Study of Prophylactic Methoxamine Infusion for Preventing Spinal-induced Hypotension during Cesarean Delivery

Tang

Chen

et al. 2019

Preprint

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Background: α-receptor agonists have been reported to be safe and effective for treating or preventing spinal-induced hypotension during cesarean delivery. As a pure α 1 adrenergic agonist, methoxamine has the advantage of reducing myocardial oxygen consumption and protecting the heart in obstetric patients compared to phenylephrine. Prophylactic infusion of vasopressor appears to be superior to bolus administration. The aim of this study was to determine the optimal prophylactic methoxamine infusion dose that would be effective for preventing spinal-induced hypotension in 50% (ED 50 ) and 95% (ED 95 ) of parturients.Methods : Eighty parturients with a singleton pregnancy scheduled for elective cesarean delivery were randomly allocated to receive prophylactic methoxamine infusion at one of four different fixedrates: 1μg/kg/min (group M1), 2μg/kg/min (group M2), 3μg/kg/min (group M3), or 4μg/kg/min (group M4). An adequate response was defined as absence of hypotension (maternal SBP <80% of baseline).The values for ED50 and ED95 of prophylactic methoxamine infusion were determined by probit regression model. The outcomes of maternal hemodynamics and fetal status were compared among the groups.Results: The calculated ED 50 and ED 95 (95% confidence interval) of prophylactic methoxamine infusion dose were 2.178 (95% CI 1.564 to 2.680) μg/kg/min and 4.821 (95% CI 3.951 to 7.017) μg/kg/min, respectively. The incidence of hypotension decreased with increasing methoxamine infusion dose (15/20, 11/20, 7/20 and 2/20 in group M1, M2, M3 and M4 respectively, P < 0.001). 1minute Apgar scores and umbilical arterial PaO2 were lower but umbilical arterial PaCO2 was higher in Group M1. No difference was found in the other incidence of adverse effects and neonatal outcomes among groups.Conclusions: Under the conditions of this study, when prophylactic methoxamine infusion was given at a fixed-rate based on body weight for preventing spinal-induced hypotension in obstetric patients, the values for ED 50 and ED 95 were 2.178μg/kg/min and 4.821μg/kg/min respectively. BackgroundHypotension is a very common complication caused by spinal anesthesia or combined spinal-epidural interval:induction-delivery interval; U-D interval:uterine incision-delivery interval. Declarations Ethics approval and consent to participateThis study was preapproved by the ethical review board of the Women's Hospital, School of Medicine, Zhejiang University (approval number 20180095), written informed consent was obtained from all subjects participating in the trial. Consent for publicationNot applicable.

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Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Cited by 51 publications

References 118 publications

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

A Randomised Dose-Response Study of Prophylactic Methoxamine Infusion for Preventing Spinal-induced Hypotension during Cesarean Delivery

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