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

Alessandro D'Ambrosio, Antonella Cotoia, Renata Beck, Potito Salatto, Lada Zibar, Gilda Cinnella, Alessandro D'Ambrosio, Antonella Cotoia, Renata Beck, Potito Salatto, Lada Zibar, Gilda Cinnella

Abstract

Background: Impedance 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.

Methods: Sixty-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.

Results: Fifteen 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.

Conclusions: ICG 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 registration: ClinicalTrials.gov: NCT03170427 . Retrospectively Registered (Date of registration: May 2017).

Keywords: Cesarean section; Hemodynamics; Hypotension; Impedance Cardiography; Levobupivacaine.

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for this study (Ethical Committee N° 18/CE/2012) was provided by the Ethical.

Committee of the University- Hospital of Foggia on 27 February 2012. A written informed consent.

was obtained from all participants in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of patients’ enrolment
Fig. 2
Fig. 2
Mean arterial pressure (mmHg) and systemic vascular resistance index (dyn-sec/cm5/m2) trend. Data are presented as mean in fifteen patients in GL6 group and fifteen patients in GL8 group. * § P < .001; ^ P = .035
Fig. 3
Fig. 3
Cardiac index (L/min/m2), heart rate (bpm) and SVI (mL/beat/m2) trends. Data are presented as mean in fifteen patients in L6 group and fifteen patients in L8 group. ° P = .003; + P = .052

References

    1. Cybulski G, Strasz A, Niewiadomski W, Gąsiorowska A. Impedance cardiography: recent advancements. Cardiol J. 2012;19:550–556. doi: 10.5603/CJ.2012.0104.
    1. Tihtonen K, Kööbi T, Yli-Hankala A, Uotila J. Maternal hemodynamics during cesarean delivery assessed by whole-body impedance cardiography. Acta Obstet Gynecol Scand. 2005;84:355–361. doi: 10.1111/j.0001-6349.2005.00489.x.
    1. Morris R, Sunesara I, Rush L, Anderson B, Blake PG, Darby M, et al. Maternal hemodynamics by thoracic impedance cardiography for normal pregnancy and the postpartum period. Obstet Gynecol. 2014;123:318–324. doi: 10.1097/AOG.0000000000000104.
    1. D’Ambrosio A, Spadaro S, Mirabella L, Natale C, Cotoia A, De Capraris A, et al. The anaesthetic and recovery profile of two concentrations (0.25% and 0.50%), of intrathecal isobaric levobupivacaine for combined spinal-epidural (CSE) anaesthesia in patients undergoing modified stark method caesarean delivery: a double blinded randomiz. Eur Rev Med Pharmacol Sci. 2013;17:3229–3236.
    1. Langesæter E, Dyer RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol. 2011;24:242–248. doi: 10.1097/ACO.0b013e32834588c5.
    1. Chaffin DG, Webb DG. Outcomes of pregnancies at risk for hypertensive complications managed using impedance cardiography. Am J Perinatol. 2009;26:717–721. doi: 10.1055/s-0029-1223283.
    1. Bremerich DH, Kuschel S, Fetsch N, Zwissler B, Byhahn C, Meininger D. Levobupivacaine for parturients undergoing elective caesarean delivery. A dose-finding investigation. Anaesthesist. 2007;56:772–779. doi: 10.1007/s00101-007-1201-1.
    1. Bouvet L, Da-Col X, Chassard D, Daléry F, Ruynat L, Allaouchiche B, et al. ED50 and ED95 of intrathecal levobupivacaine with opioids for caesarean delivery. Br J Anaesth. 2011;106:215–220. doi: 10.1093/bja/aeq296.
    1. Williamson W, Burks D, Pipkin J, Burkard JF, Osborne LA, Pellegrini JE. Effect of timing of fluid bolus on reduction of spinal-induced hypotension in patients undergoing elective cesarean delivery. AANA J. 2009;77:130–136.
    1. Camorcia M, Capogna G. Sensory assessment of epidural block for caesarean section: a systematic comparison of pinprick, cold and touch sensation. Eur J Anaesthesiol. 2006;23(7):611. doi: 10.1017/S0265021506000421.
    1. Cacciapaglia M, Cinnella G, Schiraldi R, Cormio L, Vetuschi P, Cotoia A, et al. Combined sequential spinal epidural anesthesia: a prospective study. J Anesth Clin Res. 2012;3:8–11. doi: 10.4172/2155-6148.1000232.
    1. Bromage P, Burfoot M, Crowell D, Pettigrew R. Quality of epidural blockade. I. Influence of physical factors. Br J Anaesth. 1964;36:342–352. doi: 10.1093/bja/36.6.342.
    1. Venkata H, Pasupuleti S, Pabba U, Porika S, Talari G. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section. Saudi J Anaesth. 2015;9:122–127. doi: 10.4103/1658-354X.152827.
    1. Sanghavi M, Rutherford JD, Chb MB. Cardiovascular Management in Pregnancy Cardiovascular Physiology of Pregnancy 2014;1003–1008.
    1. Robson SC, Boys RJ, Rodeck C, Morgan B. Maternal and fetal Haemodynamic effects of spinal and extradural Anaesthesia for elective caesarean section. BJA Br J Anaesth. 1992;68:54–59. doi: 10.1093/bja/68.1.54.
    1. Ramsingh D, Alexander B, Cannesson M. Clinical review: does it matter which hemodynamic monitoring system is used? Crit Care. 2013;17:208. doi: 10.1186/cc11814.
    1. Burlingame J, Ohana P, Aaronoff M, Seto T. Noninvasive cardiac monitoring in pregnancy: impedance cardiography versus echocardiography. J Perinatol. 2013;33:675–680. doi: 10.1038/jp.2013.35.
    1. KlÖhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54:909–921. doi: 10.1111/j.1399-6576.2010.02239.x.
    1. Beloncle F, Radermacher P, Guerin C, Asfar P. Mean arterial pressure target in patients with septic shock. Minerva Anestesiol. 2016:777–84.
    1. Wong MM, Pickwell-Macpherson E, Zhang YT. Impedance cardiography for cuffless and non-invasive measurement of systolic blood pressure. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:800–802.
    1. Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol. 2013:62–73.
    1. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;4:CD002251.
    1. Ueyama H, He YL, Tanigami H, Mashimo T, Yoshiya I. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section. Anesthesiology. 1999;91(6):1571. doi: 10.1097/00000542-199912000-00006.
    1. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: an effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103:744–750. doi: 10.1097/00000542-200510000-00012.
    1. Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2012;114:377–390. doi: 10.1213/ANE.0b013e3182373a3e.
    1. Nag DS, Samaddar DP, Chatterjee A, Kumar H, Dembla A. Vasopressors in obstetric anesthesia: a current perspective. World J Clin cases. 2015;3:58–64. doi: 10.12998/wjcc.v3.i1.58.
    1. Gunusen I, Karaman S, Sargin A, Firat V. A randomized comparison of different doses of intrathecal levobupivacaine combined with fentanyl for elective cesarean ection: prospective, double-blinded study. J Anesth. 2011;25:205–212. doi: 10.1007/s00540-011-1097-4.
    1. Vercauteren MP, Coppejans HC, Hoffmann VL, Saldien V, Adriaensen HA. Small-dose hyperbaric versus plain bupivacaine during spinal anesthesia for cesarean section. Anesth Analg. 1998;86:989–993. doi: 10.1213/00000539-199805000-00014.
    1. Birnbach DJ, Soens MA. Hotly debated topics in obstetric anesthesiology 2008. A theory of relativity Minerva Anestesiol. 2008:409–24.
    1. D’Ambrosio A, Spadaro S, Natale C, Cotoia A, Dambrosio M, Cinnella G. Continuous spinal analgesia with levobupivacaine for postoperative pain management: comparison of 0.125% versus 0.0625% in elective total knee and hip replacement: a double-blind randomized study. J Anaesthesiol Clin Pharmacol. 2015;31:478–484. doi: 10.4103/0970-9185.169066.
    1. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004:564–75.
    1. Saric JP, Mikulandra S, Gustin D, Matasic H, Tomulic K, Dokoza KP. Spinal anesthesia at the L2-3 and L3-4 levels: comparison of analgesia and hemodynamic response. Coll Antropol. 2012;36:151–156.
    1. Hasanin A, Aiyad A, Elsakka A, Kamel A, Fouad R, Osman M, et al. Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial. BMC Anesthesiol. 2017;17:60. doi: 10.1186/s12871-017-0349-8.
    1. Cotoia A, Mirabella L, Raimondo P, Cinnella G. Complication of regional anesthesia. In: Malvasi A, Tinelli A, Di Renzo GC, editors. Manag. Ther. Late pregnancy Complicat. Third trimester Puerperium. Springer. 2016. pp. 265–294.
    1. Mirabella L, Cotoia A, Melchionda M, Cinnella G. Complications of general anesthesia in obstetric. In: Malvasi A, Tinelli A, Di Renzo G, editors. Manag. Ther. Late pregnancy Complicat. Third trimester Puerperium. Springer. 2016. pp. 295–316.
    1. Melchiorre K, Sharma R, Khalil A, Thilaganathan B. Maternal cardiovascular function in normal pregnancy: evidence of maladaptation to chronic volume overload. Hypertension. 2016;67:754–762. doi: 10.1161/HYPERTENSIONAHA.115.06667.
    1. Ram M, Lavie A, Lev S, Blecher Y, Amikam U, Shulman Y, et al. Casting doubt on the value of assessing the cardiac index in pregnancy. J Matern Neonatal Med Informa UK Ltd. 2017;0:1–5.

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