Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan.
J Anesth. 2024 Feb;38(1):105-113. doi: 10.1007/s00540-023-03293-2. Epub 2024 Jan 3.
Spinal anesthesia is a standard technique for cesarean delivery; however, it possesses a risk of hypotension. We hypothesised that the changes in the corrected flow time induced by the Trendelenburg position could predict the incidence of hypotension after spinal anesthesia for cesarean delivery.
Patients undergoing elective cesarean delivery under spinal anesthesia were enrolled. Before anesthesia induction, corrected flow time was measured in the supine and Trendelenburg positions (FTc-1 and FTc-2, respectively). Additionally, a percent change in corrected flow time induced by the Trendelenburg position was defined as ΔFTc. The primary endpoint was to investigate the ability of ΔFTc to predict the incidence of spinal anesthesia-induced hypotension until delivery. The receiver operating characteristics curves to assess the ability of FTc-1, FTc-2, and ΔFTc to predict the incidence of hypotension were generated.
Finally, 40 patients were included, and of those, 26 (65%) developed spinal anesthesia-induced hypotension. The areas under the curve for FTc-1, FTc-2, and ΔFTc were 0.591 (95% CI: 0.424 to 0.743) (P = 0.380), 0.742 (95% CI: 0.579 to 0.867) (P = 0.004), and 0.882 (95% CI: 0.740 to 0.962) (P < 0.001) respectively, indicating ΔFTc as the best predictor among these three parameters. The best threshold for ΔFTc was 6.4% (sensitivity: 80.8% (95% CI: 53.8 to 96.2), specificity: 85.7% (95% CI: 42.9 to 100.0)).
This study demonstrated that changes in the corrected carotid flow time induced by the Trendelenburg position could serve as a good predictor of spinal anesthesia-induced hypotension for cesarean delivery.
椎管内麻醉是剖宫产的标准技术；然而，它存在低血压的风险。我们假设，Trendelenburg 体位引起的校正流量时间的变化可以预测椎管内麻醉下剖宫产低血压的发生率。
纳入接受椎管内麻醉下择期剖宫产的患者。在麻醉诱导前，分别测量仰卧位和Trendelenburg 体位下的校正流量时间（FTc-1 和 FTc-2）。此外，定义 Trendelenburg 体位引起的校正流量时间的百分比变化为 ΔFTc。主要终点是研究 ΔFTc 预测椎管内麻醉诱导至分娩期间低血压发生率的能力。生成评估 Ftc-1、Ftc-2 和 ΔFTc 预测低血压发生率的能力的接收者操作特征曲线。
最终纳入 40 例患者，其中 26 例（65%）发生椎管内麻醉诱导性低血压。FTc-1、FTc-2 和 ΔFTc 的曲线下面积分别为 0.591（95%CI：0.424 至 0.743）（P=0.380）、0.742（95%CI：0.579 至 0.867）（P=0.004）和 0.882（95%CI：0.740 至 0.962）（P<0.001），表明 ΔFTc 是这三个参数中最好的预测因子。ΔFTc 的最佳阈值为 6.4%（灵敏度：80.8%（95%CI：53.8 至 96.2），特异性：85.7%（95%CI：42.9 至 100.0））。
本研究表明，Trendelenburg 体位引起的校正颈动脉流量时间的变化可以作为预测椎管内麻醉下剖宫产低血压的良好指标。
