Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000500011
Brazilian Journal of Anesthesiology
Informação Clínica

Utilização de monitor minimamente invasivo não calibrado de débito cardíaco em pacientes submetidas à cesariana sob raquianestesia: relato de quatro casos

Use of a minimally invasive uncalibrated cardiac output monitor in patients undergoing cesarean section under spinal anesthesia: report of four cases

Fernando Bliacheriene; Maria José Carvalho Carmona; Cristina de Freitas Madeira Barretti; Cristiane Maria Federicci Haddad; Elaine Soubhi Mouchalwat; Maria Rita de Figueiredo Lemos Bortolotto; Rossana Pulcineli Vieira Francisco; Marcelo Zugaib

http://dx.doi.org/10.1590/S0034-70942011000500011 Braz J Anesthesiol, vol.61, n5, p.614-618, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: Durante cesariana sob raquianestesia observam-se alterações hemodinâmicas. São realizadas medidas de pressão arterial (PA) não invasiva e de frequência cardíaca (FC) para diagnosticar essas alterações, mas com atraso e imprecisão. Outros monitores como cateteres de pressão de enchimento e débito cardíaco (DC) com calibração externa são muito invasivos ou imprecisos. O objetivo deste estudo foi relatar as medidas de débito cardíaco obtidas por um monitor minimamente invasivo não calibrado (LiDCO rapid) em pacientes submetidas à cesariana sob raquianestesia. RELATO DO CASO: Após aprovação da comissão de ética, quatro pacientes consentiram em participar do estudo. Elas foram submetidas à cesariana sob raquianestesia quando estavam conectadas ao LiDCO rapid por uma linha arterial radial. Os dados de DC, FC e BP foram registrados no momento basal, após instalação da raquianestesia, após extração fetal e placentária e após infusão de ocitocina e metaraminol. Foram observadas queda da PA, com aumento da FC e DC após a raquianestesia e infusão de ocitocina; e aumento da BP, com queda da FC e DC após bolus de vasopressor. CONCLUSÕES: Embora não calibrado, esse monitor produziu tendência de dados consistentes sobre a hemodinâmica de pacientes obstétricas e pode ser usado como guia terapêutico ou como ferramenta de pesquisa

Palavras-chave

ANESTESIA, ANESTESIA, CIRURGIA, COMPLICAÇÕES, CUIDADOS, TÉCNICAS DE MEDIÇÃO, TÉCNICAS DE MEDIÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Hemodynamic changes are observed during cesarean section under spinal anesthesia. Non-invasive blood pressure (BP) and heart rate (HR) measurements are performed to diagnose these changes, but they are delayed and inaccurate. Other monitors such as filling pressure and cardiac output (CO) catheters with external calibration are very invasive or inaccurate. The objective of the present study was to report the cardiac output measurements obtained with a minimally invasive uncalibrated monitor (LiDCO rapid) in patients undergoing cesarean section under spinal anesthesia. CASE REPORT: After approval by the Ethics Commission, four patients agreed to participate in this study. They underwent cesarean section under spinal anesthesia while at the same time being connected to the LiDCO rapid by a radial artery line. Cardiac output, HR, and BP were recorded at baseline, after spinal anesthesia, after fetal and placental extraction, and after the infusion of oxytocin and metaraminol. We observed a fall in BP with an increase of HR and CO after spinal anesthesia and oxytocin infusion; and an increase in BP with a fall in HR and CO after bolus of the vasopressor. CONCLUSIONS: Although this monitor had not been calibrated, it showed a tendency for consistent hemodynamic data in obstetric patients and it may be used as a therapeutic guide or experimental tool

Keywords

Anesthesia, Spinal, Monitoring, Intraoperative, Hemodynamics, Cardiac Output, Hypotension, Cesarean Section

Referências

Shibli KU. Russell IF: A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth. 2000;9:160-7.

Hartley H, Seed PT, Ashworth H. Effect of lateral versus supine wedged position on development of spinal blockade and hypotension. Int J Obstet Anesth. 2001;10:182-8.

Archer TL, Knape K, Liles D. The hemodynamics of oxytocin and other vasoactive agents during neuraxial anesthesia for cesarean delivery: findings in six cases. Int J Obstet Anesth. 2008;17:247-54.

Dyer RA, James MF. Maternal hemodynamic monitoring in obstetric anesthesia. Anesthesiology. 2008;109:765-7.

Langesaeter E. Is it more informative to focus on cardiac output than blood pressure during spinal anesthesia for cesarean delivery in women with severe preeclampsia?. Anesthesiology. 2008;108:771-2.

Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology. 2008;109:856-63.

Robson SC, Boys RJ, Rodeck C. Maternal and fetal haemodynamic effects of spinal and extradural anaesthesia for elective caesarean section. Br J Anaesth. 1992;68:54-59.

Archer TL, Heitmeyer JD. Perioperative hemodynamics obtained by pulse contour analysis facilitated the management of a patient with chronic hypertension, renal insufficiency, and superimposed preeclampsia during cesarean delivery. J Clin Anesth. 2010;22:274-9.

Sharwood-Smith G, Drummond GB. Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia. Br J Anaesth. 2009;102:291-4.

Rout CC, Akoojee SS, Rocke DA. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth. 1992;68:394-7.

Ngan Kee WD, Khaw KS. Ng FF - Prevention of hypotension during spinal anesthesia for cesarean delivery: an effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103:744-50.

Macarthur A. Riley ET - Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin. 2007;45:115-32.

Ngan Kee WD, Khaw KS, Ng FF. Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2004;98:815-21.

Lee SW, Khaw KS, Ngan Kee WD. Management of hypotension in obstetric spinal anaesthesia. Br J Anaesth. 2009;103:457-8.

Vallejo MC, Ramanathan S. Should alpha-agonists be used as first line management of spinal hypotension?. Int J Obstet Anesth. 2003;12:243-5.

Carvalho JC, Balki M, Kingdom J. Oxytocin requirements at elective cesarean delivery: a dose-finding study. Obstet Gynecol. 2004;104:1005-10.

Tsen LC, Balki M. Oxytocin protocols during cesarean delivery: time to acknowledge the risk/benefit ratio?. Int J Obstet Anesth. 2010;19:243-5.

Dyer RA, Piercy JL, Reed AR. Hemodynamic changes associated with spinal anesthesia for cesarean delivery in severe preeclampsia. Anesthesiology. 2008;108:802-11.

Dyer RA, Reed AR, van Dyk D. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009;111:753-65.

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