Clinical evaluation of the flotrac/Vigileo system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study

José Otavio Costa Auler Jr, Marcelo L A Torres, Mônica M Cardoso, Thais C Tebaldi, André P Schmidt, Mario M Kondo, Marcelo Zugaib, José Otavio Costa Auler Jr, Marcelo L A Torres, Mônica M Cardoso, Thais C Tebaldi, André P Schmidt, Mario M Kondo, Marcelo Zugaib

Abstract

Background: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo system in patients undergoing spinal anesthesia for elective cesarean section.

Methods: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis.

Results: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time.

Discussion and conclusions: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

Keywords: Cardiac output; Cesarean section; FloTrac/Vigileo™; Spinal anesthesia; Stroke volume.

References

    1. Connors AF, Jr, Speroff T, Dawson NV, Thomas C, Harrell FE, Jr, Wagner D, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA. 1996;276:889–97.
    1. Sandham JD, Hull RD, Brant RF, Knox L, Pineo GF, Doig CJ, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med. 2003;348:5–14.
    1. Rhodes A, Grounds RM. New technologies for measuring cardiac output: the future? Curr Opin Crit Care. 2005;11:224–6.
    1. Halvorsen PS, Espinoza A, Lundblad R, Cvancarova M, Hol PK, Fosse E, et al. Agreement between PiCCO pulse-contour analysis, pulmonal artery thermodilution and transthoracic thermodilution during off-pump coronary artery by-pass surgery. Acta Anaesthesiol Scand. 2006;50:1050–7.
    1. Goedje O, Hoeke K, Lichtwarck-Aschoff M, Faltchauser A, Lamm P, Reichart B. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med. 1999;27:2407–12.
    1. Gödje O, Höke K, Goetz AE, Felbinger TW, Reuter DA, Reichart B, et al. Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during haemodynamic instability. Crit Care Med. 2002;30:52–8.
    1. Felbinger TW, Reuter DA, Eltzschig HK, Bayerlein J, Goetz AE. Cardiac index measurements during rapid preload changes: a comparison of pulmonary artery thermodilution with arterial pulse contour analysis. J Clin Anesth. 2005;17:241–8.
    1. Westphal GA, Silva E, Gonçalves AR, Caldeira Filho M, Poli-de-Figueiredo LF. Pulse oximetry wave variation as a noninvasive tool to assess volume status in cardiac surgery. Clinics. 2009;64:337–43.
    1. Manecke GR. Edwards FloTrac sensor and Vigileo monitor: easy, accurate, reliable cardiac output assessment using the arterial pulse wave. Expert Rev Med Devices. 2005;2:523–7.
    1. Manecke GR, Jr, Auger WR. Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth. 2007;21:3–7.
    1. Mayer J, Boldt J, Schollhorn T, Rohm KD, Mengistu AM, Suttner S. Semi-invasive monitoring of cardiac output by a new device using arterial pressure waveform analysis: a comparison with intermittent pulmonary artery thermodilution in patients undergoing cardiac surgery. Br J Anaesth. 2007;98:176–82.
    1. Opdam HI, Wan L, Bellomo R. A pilot assessment of the FloTracTM cardiac output monitoring system. Intensive Care Med. 2006;33:344–9.
    1. Cannesson M, Attof Y, Rosamel P, Joseph P, Bastien O, Lehot JJ. Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements. Eur J Anaesthesiol. 2007;24:832–9.
    1. Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH. Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patients. Br J Anaesth. 2008;100:451–6.
    1. Mayer J, Boldt J, Wolf MW, Lang J, Suttner S. Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. Anesth Analg. 2008;106:867–72.
    1. Tihtonen K, Kööbi T, Yli-Hankala A, Huhtala H, Uotila J. Maternal haemodynamics in pre-eclampsia compared with normal pregnancy during caesarean delivery. BJOG. 2006;113:657–63.
    1. Dyer RA, Piercy JL, Reed AR, Lombard CJ, Schoeman LK, James MF. Hemodynamic changes associated with spinal anesthesia for cesarean delivery in severe preeclampsia. Anesthesiology. 2008;108:802–11.
    1. Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg. 2009;108:1592–8.
    1. Pearse RM, Ikram K, Barry J. Equipment review: an appraisal of the LiDCO™ plus method of measuring cardiac output. Crit Care. 2004;8:190–5.
    1. Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008;109:856–63.
    1. Santos AC, Birnbach DJ. Spinal anesthesia in the parturient with severe preeclampsia: Time for reconsideration. Anesth Analg. 2003;97:621–2.
    1. Aya AG, Vialles N, Tanoubi I, Mangin R, Ferrer JM, Robert C, et al. Spinal anesthesia-induced hypotension: A risk comparison between patients with severe preeclampsia and healthy women undergoing preterm cesarean delivery. Anesth Analg. 2005;101:869–75.
    1. Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: A prospective cohort comparison. Anesth Analg. 2003;97:867–72.
    1. Robson SC, Boys RJ, Rodeck C, Morgan B. Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth. 1992;68:54–9.
    1. Pauca AL. Pressure Wave Analysis Is Useful to Understand the Pathophysiology of Preeclampsia, but Perhaps Not the Rapid Changes during Cesarean Delivery. Anesthesiology. 2008;108:773–4.
    1. Langesaeter E. Is It More Informative to Focus on Cardiac Output than Blood Pressure during Spinal Anesthesia for Cesarean Delivery in Women with Severe Preeclampsia? Anesthesiology. 2008;108:771–2.
    1. Young P, Johanson R. Haemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient. Best Pract Res Clin Obstet Gynaecol. 2001;15:605–22.
    1. Mesa A, Jessurun C, Hernandez A, Adam K, Brown D, Vaughn WK, et al. Left ventricular diastolic function in normal human pregnancy. Circulation. 1999;99:511–7.
    1. Pinder AJ, Dresner M, Calow C, Shorten GD, O'Riordan J, Johnson R. Haemodynamic changes caused by oxytocin during caesarean section under spinal anaesthesia. Int J Obstet Anesth. 2002;11:156–9.
    1. Carvalho JC, Balki M, Kingdom J, Windrim R. Oxytocin requirements at elective cesarean delivery: A dose-finding study. Obstet Gynecol. 2004;104:1005–10.
    1. Dahl MK, Vistisen ST, Koefoed-Nielsen J, Larsson A. Using an expiratory resistor, arterial pulse pressure variations predict fluid responsiveness during spontaneous breathing: an experimental porcine study. Crit Care. 2009;13:R39.
    1. Dyer RA, Reed AR, van Dyk D, Arcache MJ, Hodges O, Lombard CJ, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009;111:753–65.
    1. Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med. 2007;33:1117–24.
    1. de Backer D, Pinsky MR. Can one predict fluid responsiveness in spontaneously breathing patients? Intensive Care Med. 2007;33:1111–3.

Source: PubMed

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