Investigation of Heart Rate Variability and The Requirement for Vasopressors Relationship Due to Hypotension in Patients Undergoing Caesarean Section with Spinal Anesthesia
Downloads
Introduction: The most common effect of spinal anesthesia applied in cesarean section operations is hypotension. It is very important to prevent hypotension due to fetal bradycardia, acidosis, and maternal effects. Objective: This research was conducted to predict and prevent maternal hypotension in pregnant women undergoing elective cesarean section with spinal anesthesia by measuring heart rate variability parameters about hypotension. Methods: The study included pregnant women aged 18-45 with ASA 2 classification who underwent elective cesarean section with spinal anesthesia. Using the 'CorSense Heart Rate Variability Finger Sensor by Elite HRV' device and its smartphone application, 102 volunteer pregnant patients were monitored for 5 minutes in the recovery unit, and their data were recorded. After the administration of spinal anesthesia, patients who exhibited a decrease in systolic blood pressure of 20% or more from their baseline values received intravenous ephedrine in 10 mg bolus doses at each instance of low blood pressure measurements. Patients who received a total of 20 mg or more ephedrine doses or more as needed were designated as 'Group 1,' while patients who received less than 20 mg or no ephedrine were classified as 'Group 2.' Results: This study was completed with a total of 102 pregnant patients With 46 patients in Group 1 and 56 patients in Group 2, the relevant parameters that showed a statistically significant difference between patient groups were subjected to ROC analysis for predicting hypotension. It was determined that patients with high HF POWER and TOTAL POWER values had a greater need for vasopressors due to hypotension following spinal anesthesia (p<0.05). Conclusion: In the research, these values are believed to have the potential to predict hypotension in patients undergoing cesarean sections with spinal anesthesia.
Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane database Syst Rev. 2017 Aug;8(8):CD002251.
Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia. 2020;75(1):109–21.
Yu C, Gu J, Liao Z, Feng S. Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies. Int J Obstet Anesth. 2021;47(20).
Hung KC, Liu CC, Huang YT, Wu JY, Chen JY, Ko CC, et al. Predictive Efficacy of the Perfusion Index for Hypotension following Spinal Anesthesia in Parturient Undergoing Elective Cesarean Section: A Systematic Review and Meta-Analysis. Diagnostics. 2023;13(15).
Bishop DG, Cairns C, Grobbelaar M, Rodseth RN. Obstetric spinal hypotension: Preoperative risk factors and the development of a preliminary risk score –The PRAM score. South African Med J. 2017;107(12):1127–31.
Min KB, Min JY, Paek D, Cho S Il, Son M. Is 5-minute heart rate variability a useful measure for monitoring the autonomic nervous system of workers? Int Heart J. 2008;49(2):175–81.
Danelli G, Zangrillo A, Nucera D, Giorgi E, Fanelli G, Senatore R, et al. The minimum effective dose of 0.5% hyperbaric spinal bupivacaine for cesarean section. Minerva Anestesiol. 2001;67(7–8):573–7.
Maheshwari K, Shimada T, Yang D, Khanna S, Cywinski JB, Irefin SA, et al. Hypotension Prediction Index for Prevention of Hypotension during Moderate- to High-risk Noncardiac Surgery: A Pilot Randomized Trial. Anesthesiology. 2020;133(6):1214–22.
Etemadi M, Hogue CW. Preventing Intraoperative Hypotension: Artificial Intelligence versus Augmented Intelligence? Anesthesiology. 2020;133(6):1170–2.
Yeh P-H, Chang Y-J, Tsai S-E. Observation of hemodynamic parameters using a non-invasive cardiac output monitor system to identify predictive indicators for post-spinal anesthesia hypotension in parturients undergoing cesarean section. Exp Ther Med. 2020;20(6):1–1.
Kang YG, Abouleish E, Caritis S. Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section. Anesth Analg. 1982;61(10):839–42.
Thomas BL, Claassen N, Becker P, Viljoen M. Validity of Commonly Used Heart Rate Variability Markers of Autonomic Nervous System Function. Neuropsychobiology. 2019;78(1):14–26.
Frandsen MN, Mehlsen J, Foss NB, Kehlet H. Preoperative heart rate variability as a predictor of perioperative outcomes: a systematic review without meta-analysis. J Clin Monit Comput [Internet]. 2022;36(4):947–60. Available from: https://doi.org/10.1007/s10877-022-00819-z
Eller NH. Total power and high frequency components of heart rate variability and risk factors for atherosclerosis. Auton Neurosci. 2007 Jan;131(1–2):123–30.
Vinayagam S, Panta S, Badhe A, Sharma V. Heart rate variability as a predictor of hypotension after spinal anaesthesia in patients with diabetes mellitus. Indian J Anaesth. 2019;63(8):671–3.
Shehata JH, El Sakka AI, Omran A, Gbre MAMA, Mohamed AA, Fetouh AM, et al. Heart Rate Variability as A Predictor of Hypotension Following Spinal Anesthesia for Elective Caesarian Section in Preeclamptic Parturients: A Descriptive Observational Study. Open access Maced J Med Sci. 2019 Dec;7(23):4043–7.
Copyright (c) 2024 Kübra Bektaş, Duygu Yücel, Fatih Uğur
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Indonesian Journal of Anesthesiology and Reanimation (IJAR) licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. Copyright holder is the author.
2. The journal allows the author to share (copy and redistribute) and adapt (remix, transform, and build) upon the works under license without restrictions.
3. The journal allows the author to retain publishing rights without restrictions.
4. The changed works must be available under the same, similar, or compatible license as the original.
5. The journal is not responsible for copyright violations against the requirement as mentioned above.