Impedance cardiography as tool for continuous hemodynamic monitoring during cesarean section: randomized, prospective double blind study

Abstract

BackgroundImpedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia.MethodsSixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups. Mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate (HR), stroke volume index (SVI) were recorded from Tbaseline to 31 min after CSE by ICG. Sensory and motor blocks, patients and surgeons satisfaction, neonatal data were also recorded.ResultsFifteen of 32 patients in GL6 and 15 of 30 patients in GL8 experienced hypotension at T2 vs Tbaseline (P < .001) and SVRI reduction (P = .035 and P < .001 respectively). MAP, CI and SVRI were always slightly higher in GL6 vs GL8. HR and SVI remained stable until the end of surgery in all patients. Total ephedrine requirements was higher in GL8 (P = .010). The onset and offset time of sensory and motor block were similar in both groups, but the number of patients with motor block was lower in GL6 vs GL8 (P = .001). Patients and surgeon satisfaction scores, the number of patients needed systemic rescue doses, neonatal data were similar in both groups.ConclusionsICG is a useful noninvasive tool to monitor continuously hemodynamics during cesarean section. The hemodynamic stability, the satisfying sensory block and rapid mobilization provided by low levobupivacaine dose may be particularly advantageous in obstetric patients.Trial registrationClinicalTrials.gov: NCT03170427. Retrospectively Registered (Date of registration: May 2017).

Effectiveness of Combined Strategies for the Prevention of Hypothermia Measured by Noninvasive Zero-Heat Flux Thermometer During Cesarean Section

“…Moreover, PH can increase oxygen consumption and catecholamines release, which are responsible of intraoperative complications, such as hypoxia and increased pulmonary vascular resistances, and postoperative shivering can increase the metabolic rate leading to an increased incidence of early postoperative myocardial ischemia, especially in high risk-patients ( 15 , 16 ).…”

Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues

“…A final consideration for these kind of pregnant women concerns delivery management since these AMA women have to be considered risk patients and have to be treated by a multidisciplinary medical team. A cesarean section is recommended to be induced in general anesthesia with continuous haemodynamics semi invasive monitoring of blood pressure, heart rate, stroke volume, cardiac output or cardiac index and systemic vascular resistance, avoiding drugs that produce myocardial depression, maintaining normovolaemia and preventing increased afterload (Vigileo, NICaS, ICG) [67,68,69,70]. If the neuraxial technique of anesthesia is practiced, low drug doses and combined spinal-epidural anesthesia have to be used [71].…”

Hemodynamic differences among hypertensive patients with and without heart failure using impedance cardiography

“…In 2017 a randomized, prospective double-blind study enhanced the utility of maternal hemodynamic monitoring during spinal anesthesia for cesarean section 6 and relevant recent studies have shown that ICG hemodynamic monitoring in the operating theater reduces morbidity and shortens the length of hospital stay following surgery. 7…”