Document Detail


Systemic vascular resistance index determined by thoracic electrical bioimpedance predicts the risk for maternal hypotension during regional anesthesia for cesarean delivery.
MedLine Citation:
PMID:  8633629     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our purpose was to evaluate the predictive value of the baseline systemic vascular resistance index for the development of maternal hypotension during regional anesthesia for cesarean delivery. STUDY DESIGN: Patients receiving a standardized spinal or epidural anesthetic for nonemergency cesarean delivery were studied prospectively. Hemodynamic data were obtained noninvasively with an NCCOM-3 cardiac output monitor (Bomed Medical Manufacturing, Irvine, Calif.), which uses thoracic electrical bioimpedance to estimate stroke volume and cardiac output. Measurements obtained were indexed to body surface area. The systemic vascular resistance index was calculated from mean arterial pressure and thoracic electrical bioimpedance-derived cardiac index. Hemodynamic data obtained were analyzed to identify statistically significant predictors of maternal hypotension. RESULTS: Maternal hypotension occurred in 24 of 42 (57%) patients studied. The incidence of hypotension did not differ between the types of anesthesia: spinal 17 of 274 (62%) versus epidural 7 of 15 (47%, p=0.48). The mean interval to the onset of hypotension was 12.2 minutes (SD 2.2 minutes, range 2 to 24 minutes). Mean (SD) baseline maternal systolic blood pressure was higher in patients who had hypotension (145 torr [4]) than those who did not (129 torr [4], p=0.01). The mean (SD) baseline systemic vascular resistance index was higher in patients who had hypotension (633 [SD 36] dyne . cm . sec-5/m2) than those who did not (454 [SD 29] dyne . cm . sec-5/m2; p =0.001). With receiver-operator characteristic curves, a baseline systemic vascular resistance index of 500 had a sensitivity of 83%, a specificity of 78%, a positive predictive value of 83%, and a negative predictive value of 78% for maternal hypotension (odds ratio 17.5, 95% confidence interval 3.1 to 109.4). A baseline systolic blood pressure of 140 torr had a sensitivity and specificity of 42% and 72%, respectively (odds ratio 1.9, 95% confidence interval 0.4 to 8.8). CONCLUSIONS: Baseline systemic vascular resistance index obtained by noninvasive cardiac output monitoring with thoracic electrical bioimpedance and systolic blood pressure are useful to predict the risk for maternal hypotension with regional anesthesia. Patients with increased baseline systemic vascular resistance index or systolic blood pressure are at increased risk for hypotension.
Authors:
J G Ouzounian; D I Masaki; T K Abboud; J S Greenspoon
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  174     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1996 Mar 
Date Detail:
Created Date:  1996-07-03     Completed Date:  1996-07-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1019-25     Citation Subset:  AIM; IM    
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Medical Center, Los Angeles 90033, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Analysis of Variance
Anesthesia, Conduction / adverse effects*
Anesthesia, Epidural / adverse effects
Anesthesia, Obstetrical / adverse effects*
Anesthesia, Spinal / adverse effects
Blood Pressure
Cardiac Output
Cesarean Section*
Electric Impedance
Female
Humans
Hypotension / diagnosis*,  etiology,  physiopathology
Intraoperative Complications / diagnosis*,  etiology,  physiopathology
Odds Ratio
Predictive Value of Tests
Pregnancy
Prospective Studies
ROC Curve
Risk Factors
Sensitivity and Specificity
Thorax
Vascular Resistance*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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