Positional blood pressure change and the risk of hypotension during spinal anesthesia for cesarean delivery: an observational study.
BACKGROUND
We investigated whether preoperative positional arterial blood pressure change predicted hypotension and ephedrine requirement during spinal anesthesia for cesarean delivery.


METHODS
Arterial blood pressure was measured in 66 women undergoing cesarean delivery in the supine and the right lateral positions. Positional blood pressure change was defined as the difference between mean blood pressure in the right lateral and supine positions. Hypotension (<80% baseline) was recorded, and severe hypotension (<70% baseline) was treated with ephedrine.


RESULTS
The mean (range) positional blood pressure change was 11 (3-29) mm Hg, and the incidence of hypotension was 41%. Positional blood pressure change and heart rate correlated with hypotension (P < 0.001 for both) and ephedrine requirement (P = 0.004). Positional blood pressure change in those who developed hypotension was higher than for those without hypotension (mean (SD), 17 (6) vs. 7 (2) mm Hg, P < 0.001).


CONCLUSIONS
A preoperative increase in blood pressure after position change may be a good variable to predict hypotension during spinal anesthesia for cesarean delivery.
Jeon
Young-Tae
YT
Department of Anesthesia and Pain Medicine, Seoul National University Bundang Hospital, 300 Gumidong, Bundang, Seongnam, Kyonggi 463-707 South Korea.
Hwang
Jung-Won
JW
Kim
Mi-Hyun
MH
Oh
Ah-Young
AY
Park
Kyo Hoon
KH
Park
Hee-Pyoung
HP
Lee
Younsuk
Y
Do
Sang-Hwan
SH
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology*; D002585:Cesarean Section; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000453:epidemiology* / Q000209:etiology*; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D016015:Logistic Models; D016017:Odds Ratio; D011184:Postoperative Period; D011187:Posture / Q000502:physiology*; D011247:Pregnancy; D012306:Risk; D016683:Supine Position / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004809:Ephedrine