doiSerbia

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

Vukotić Aleksandra (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia), vukotica.a@gmail.com
Jevđić Jasna (University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia + Clinical Center Kragujevac, Department of Anesthesiology and Reanimation, Kragujevac, Serbia)
Green David (King’s College Hospital NHS Foundation Trust, Department of Anesthetics, Intensive Care and Pain Relief, Denmark Hill, London SE RS UK)
Vukotić Milovan (Banjica Institute for Orthopedic Surgery, Department for Anesthesia, Reanimatology and Intensive Care, Belgrade, Serbia)
Petrović Nina (University of Belgrade, Vinča Institute of Nuclear Sciences – National Institute of the Republic of Serbia, Department of Health and Environment, Laboratory for Radiobiology and Molecular Genetics, Belgrade, Serbia)
Janićijević Ana (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia)
Nenadić Irina (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia)
Boboš Marina (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia)
Čuljić Radmila (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia)
Zagorac Zagor (Dr Dragiša Mišovic - Dedinje University Clinical Hospital Center, Clinic for Surgery, Belgrade, Serbia)
Stevanović Predrag (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Reanimatology, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)

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, noninvasive blood pressure monitoring (NIBP) frequently leads to missed hypotensive episodes. The objective 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 threeminute intervals, starting from SA, by the end of the surgery. Results. In E group, significantly lower mean systolic blood pressure (SBP) values with CNAP compared with NIBP (p = 0.008) was detected. By monitoring CNAP, we 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. By monitoring CNAP, we 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 more efficient in hypotension detection for CS during SA, which allows faster treatment of hypotension, thus improving fetal and maternal outcome.

Keywords: Spinal anesthesia, cesarean section, hemodynamic monitoring, hypotension