Pressure Wave Analysis Is Useful to Understand the Pathophysiology of Preeclampsia, but Perhaps Not the Rapid Changes during Cesarean Delivery

Anesthesiology (Impact Factor: 5.88). 06/2008; 108(5):773-4. DOI: 10.1097/ALN.0b013e31816bbde5
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Available from: Alfredo Pauca, Jul 02, 2014
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    ABSTRACT: Accurate determination of defibrillation @) strength requirements @SR) in animal experiments requires fitting curves to conversion data The resultant D probability curve (DPC) relates DSR to D probability. Conventional methods for determining DPCs use a single internal test shock (S) followed by a transthoracic rescue shock if needed [91. We hypothesized that giving multiple shocks at -5 s intervals (M) during a fibrillation episode would yield an improved technique in the pig model. To compare the S and M protocols, paired values (1143) of peak current at 50% D probability (150) were obtained in 23 pigs. "%e ratio (S/M) was 1.02kO.16. M yielded 150s that are not different than those obtained from S and decxeased the time required to compared merits by -30%.
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    ABSTRACT: 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. 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. 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. 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.
    Full-text · Article · Jun 2010 · Clinics (São Paulo, Brazil)
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