Cardiac Output
Conditions
Keywords
cardiometry, uterine displacement
Brief summary
The aim of the study is to investigate the effect of different angles of lateral tilt on the maternal hemodynamics before and after spinal anesthesia
Detailed description
At operating room, patients will be monitored using non invasive blood, ECG, pulse oximeter and electrical cardiometry. Baseline readings will be taken in supine position then repeated after putting the patient in left lateral position with angle 15 then 30 degrees. Then two IV lines will be inserted and 500cc crystalloid will be administered. Subarachnoid block will be performed in sitting position under complete aseptic conditions using 25 g spinal needle. Subarachnoid block will be achieved by injecting 10 mg hyperbaric bupivacaine plus 25 ug fentanyl. The block will be considered successful if adequate block reached T4 dermatome. After successful block the hemodynamic variables will be recorded in the same positions as before (0,15, 30 degrees left uterine tilt). A minimum number of 61 patients was calculated to have a study power of 80% and alpha error of 0.05. SPSS Chicago 18 software will be used for data analysis. Categorical data will be presented as frequencies, continuous variables will presented as mean ± standard deviation and will be analyzed using on way analysis of variance (ANOVA) with post-hoc pairwise comparisons using bonferroni test. A P value of 0.05 will be considered statistically significant.
Interventions
PROCEDUREelectric cardiometry
The following measured variables were recorded using electric cardiometry heart rate, stroke volume, cardiac output, systemic vascular resistance. these parameters are measured on arrival to operating room before subarachnoid block in three different angles of lateral uterine tilt ( 0, 15 and 30 degrees )
PROCEDUREIV line insertion
two Iv lines are inserted and 500cc crystalloid is administered to parturient .
PROCEDUREspinal anesthesia ( subarachnoid block )
Subarachnoid block (SAB) was performed in sitting position under complete asepsis using 25 g spinal needle. SAB was achieved by intrathecal injection of 10 mg hyperbaric bupivacaine plus 25ug fentanyl. Success of SAB was tested within five minutes after drug injection. SAB was considered successful if adequate block reached T4 dermatome.
Sponsors
Cairo University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
20 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* full term, singleton, American society of anesthesiologists (ASA) I and II pregnant women scheduled for cs
Exclusion criteria
* BMI \> 35 Kg/m2 * polyhydramnios * history of impaired cardiac contractility * valvular heart disease * cardiac arrhythmias * hypertensive pregnancy disorders * fetal abnormalities
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in cardiac output (L/min) before anesthesia | baseline : 5min after putting the patient in supine position then 1min after left uterine tilt at 15 and 30 degrees | measured by electric cardiometry (ICON; Cardiotonic, Osypka; Berlin, Germany). |
| change in cardiac output (L/min) after spinal anesthesia | baseline after assessing adequate block reaching T4 dermatome then 1 min after left uterine tilt at 15 and 30 degrees | measured by electric cardiometry (ICON; Cardiotonic, Osypka; Berlin, Germany). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change in systemic vascular resistance (dyn.s/cm5) | baseline : 5min after putting the patient in supine position ( at 0, 15, 30 left uterine tilt ). Then 1 min after assuring adequate level of spinal block | — |
| change in mean arterial blood pressure (mmHg) | baseline : 5min after putting the patient in supine position ( at 0, 15, 30 left uterine tilt ). Then 1 min after assuring adequate level of spinal block | measured by oscillometry in mmHg |
Outcome results
None listed