Highlights
- •Identifying risk factors might improve prevention of spinal-induced hypotension.
- •Baseline non-invasive stroke volume variation with passive leg raising was assessed.
- •Pre-spinal stroke volume change predicted hypotension after spinal anesthesia.
- •Assessment of change in stroke volume may help prevent hypotension.
Abstract
Background
Spinal anesthesia for cesarean delivery is accompanied by hypotension in up to 70%
of cases. To date, there is no gold standard for predicting hypotension after spinal
anesthesia for cesarean delivery. The Clearsight™ device is a non-invasive system
that uses a digital cuff to calculate stroke volume. We hypothesized that stroke volume
variation induced with passive leg raising before spinal anesthesia for elective cesarean
delivery could predict the occurrence of hypotension.
Methods
We conducted a prospective observational study, including third trimester parturients
undergoing elective cesarean delivery with spinal anesthesia. We analyzed the stroke
volume variation performance for predicting hypotension. Stroke volume was collected
in the semi-recumbent position (baseline) and during passive leg raising before spinal
anesthesia. Systolic arterial blood pressure measurement was followed for 15 min after
spinal anesthesia. Hypotension was defined as a ≥20% decrease from the baseline measurement.
All parturients received appropriate hypotension prophylaxis.
Results
Data from 42 parturients were analyzed. Hypotension occurred in 45%. The area-under-the
curve for predicting hypotension using the stroke volume variation was 0.83 (95% CI
0.68 to 0.98; P=0.001). The best cut-off value for predicting hypotension was 7%, having a sensitivity
of 87% (95% CI 0.70 to 0.99) and a specificity of 83% (95% CI 0.69 to 0.97).
Conclusion
In our study of third trimester parturients undergoing cesarean delivery and receiving
appropriate hypotension prophylaxis, a digital non-invasive monitoring device of stroke
volume variation analysis was useful for predicting the occurrence of hypotension
after spinal anesthesia.
Keywords
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Article info
Publication history
Published online: December 29, 2021
Accepted:
December 23,
2021
Identification
Copyright
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