Hemodynamic profiles with and without left uterine displacement: A randomized study in term pregnancies receiving subarachnoid blockade for cesarean delivery

• Published in: Journal of clinical anesthesia 2020-09, Vol.64, p.109796-109796, Article 109796
• Main Authors: Chungsamarnyart, Yanipan, Wacharasint, Petch, Carvalho, Brendan
• Format: Article
• Language: English
• Subjects: Anesthesia; Blood pressure; Cardiac output; Cesarean delivery; Cesarean section; Data collection; Hemodynamic; Hemodynamics; Hypotension; Left uterine displacement; Patients; Pregnancy; Studies; Subarachnoid blockade; Surgery; Variables; Variance analysis; Womens health
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2020.109796

The aim of this study was to evaluate the effect of left uterine displacement (LUD) on maternal hemodynamic measures following subarachnoid blockade (SAB) for cesarean delivery (CD). The primary outcome was cardiac output (CO) differences between the LUD and non-LUD groups pre-delivery. Prospective, randomized, controlled study. Obstetric operating room. We studied hemodynamic profiles in sixty healthy women with term pregnancies who underwent elective CD with SAB. Hemodynamics were measured using a non-invasive CO monitor, the Nexfin™. All women received a crystalloid 10 mL/kg preload, and hypotension was treated with ephedrine boluses. Sixty women with term pregnancies were randomized into two groups: LUD group (received 15–30° LUD after SAB, n = 30) and non-LUD group (no LUD after SAB, n = 30). Patient's hemodynamic variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), CO, systemic vascular resistance (SVR), and left ventricular contractility index (dP/dT) were measured continuously from pre-SAB until end of surgery. In pre-delivery phase at 5 min after spinal anesthesia, the LUD group had significantly higher CO (7.20 ± 1.78 [95%CI 6.53–7.87] vs. 6.23 ± 1.44 L/min [95% CI 5.69–6.77]; p = 0.016) and higher dP/dT (784 ± 313 vs. 604 ± 241 mmHg/s; p = 0.020) than the non-LUD group. The LUD group had a lower incidence of maternal systolic hypotension at 5-min post-SAB (16.7% vs. 53.3% in non-LUD group, p = 0.003). The study demonstrates modest hemodynamic advantages (higher CO, less hypotension, higher dP/dT) with pre-delivery LUD. The results support maternal hemodynamic benefits of LUD until delivery in women with term pregnancies undergoing CD with SAB. •Hemodynamics of left uterine displacement for cesarean with spinal anesthesia•A non-invasive cardiac output monitor assessed maternal hemodynamic parameters.•Higher cardiac output and less hypotension with uterine displacement vs. supine•Higher early left ventricular contractility if uterine displacement vs. supine