Per-operative cerebral near-infrared spectroscopy (NIRS) predicts maternal hypotension during elective caesarean delivery in spinal anaesthesia

Spinal anaesthesia-induced maternal hypotension is common during elective caesarean section. This study evaluated whether cerebral near-infrared spectroscopy predicts maternal hypotension, defined as a ⩾25% reduction in systolic blood pressure or heart rate or presentation of clinical symptoms. Thir...

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Bibliographic Details
Published in:International journal of obstetric anesthesia 2005, Vol.14 (1), p.26-31
Main Authors: Berlac, P.A., Rasmussen, Y.H.
Format: Article
Language:English
Subjects:
Adult
Anaesthetic techniques
Anesthesia, Obstetrical
Anesthesia, Spinal
Brain - metabolism
Cerebral oximetry
Cesarean Section
Elective Surgical Procedures
Ephedrine - pharmacology
Female
Humans
Hypotension
Hypotension - diagnosis
Intraoperative Complications - diagnosis
Near-infrared spectroscopy
Obstetric
Oxygen - metabolism
Pregnancy
Spectroscopy, Near-Infrared
Spinal anaesthesia
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Summary:Spinal anaesthesia-induced maternal hypotension is common during elective caesarean section. This study evaluated whether cerebral near-infrared spectroscopy predicts maternal hypotension, defined as a ⩾25% reduction in systolic blood pressure or heart rate or presentation of clinical symptoms. Thirty-eight ASA I-II parturients scheduled for elective caesarean section with spinal anaesthesia were monitored by near-infrared spectroscopy for changes in cerebral oxygenation (ScO 2) with the recordings blinded to the anaesthesiologist. There was a ⩾5% decrease in ScO 2 (median 8%, interquartile range 5-11%) in all 22 patients who developed hypotension, whereas only 2 of 13 women who did not develop hypotension had a ⩾5% decrease in ScO 2. Median time from a 5% decrease in ScO 2 to hypotension was 81 (interquartile range 30-281) s. The sensitivity of near-infrared spectroscopy to predict hypotension was 1.00, with a specificity 0.85 and a predictability of 0.91. The results demonstrate a relationship between ScO 2 and impending hypotension during low-dose spinal anaesthesia for elective caesarean section. We suggest that immediate measures are taken to stabilise blood pressure if the near-infrared spectroscopy determined cerebral oxygenation decreases by more than 5%.
ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2004.06.003