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


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.
Auler
José Otavio Costa
JO
Department of Anesthesia and Critical Care, Heart Institute, Hospital das Clínicas, Universidade de Sao Paulo, Sao Paulo, Brazil, SP. auler@hcnet.usp.br
Torres
Marcelo L A
ML
Cardoso
Mônica M
MM
Tebaldi
Thais C
TC
Schmidt
André P
AP
Kondo
Mario M
MM
Zugaib
Marcelo
M
D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction; D000775:Anesthesia, Spinal; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology*; D002585:Cesarean Section; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008991:Monitoring, Physiologic / Q000295:instrumentation; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D055815:Young Adult