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A three minutes supine position test reveals higher risk of spinal anesthesia induced hypotension during cesarean delivery. An observational study.

机译：三分钟的仰卧位测试显示剖宫产过程中脊髓麻醉引起的低血压风险更高。一项观察性研究。

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>Background: Cesarean delivery is performed under spinal anesthesia, and vasodilation is the main cause for a drop in blood pressure. The compression of the aorta and inferior vena cava by the gravid uterus is of additional clinical importance. Hypotension may occur during cesarean delivery even if prophylactic infusion of phenylephrine is practiced. We have tested if a 3 minute supine observation, can identify a subset of women with decreasing systolic arterial pressure (SAP) under spinal anesthesia. >Methods: We performed a prospective observational study at Oslo University Hospital on healthy pregnant women for planned cesarean delivery. Continuous measurements of calibrated invasive SAP and estimated cardiac output were recorded for 76 women in a 3 minutes measurement with the woman in the left lateral position, followed by supine position for 3 minutes. Using functional data clustering, principal component analysis and curve smoothing, to filter way noise and reduce the dimensionality of the signal, we clustered the women into separate SAP groups.   >Results: We identified two significantly different groups of women during supine position; one characterized by initial drop in SAP, the other showed initial increase. After spinal anesthesia, the mean SAP curve of the women in the first group showed a drop in blood pressure, which was more rapid than for the other women. A minor difference in cardiac output was observed between the two groups of women with the mean cardiac output curve for the first group being higher. >Conclusions: This work indicates that supine position affect clinically relevant cardiovascular measurements in pregnant women. A simple test may identify patients with increased risk of spinal anesthesia induced hypotension.
机译：>背景：剖宫产是在脊髓麻醉下进行的，血管舒张是导致血压下降的主要原因。妊娠子宫对主动脉和下腔静脉的压迫具有额外的临床意义。即使进行预防性输注去氧肾上腺素，剖宫产过程中也可能发生低血压。我们测试了3分钟的仰卧观察是否可以识别出在脊髓麻醉下收缩期动脉压（SAP）降低的女性子集。 >方法：我们在奥斯陆大学医院对计划进行剖宫产的健康孕妇进行了一项前瞻性观察研究。在3分钟的测量中，记录了76名女性的校准侵入性SAP的连续测量值和估计的心输出量，该女性在左侧卧位，然后仰卧位3分钟。通过使用功能数据聚类，主成分分析和曲线平滑处理，以过滤道路噪声并降低信号的维数，我们将女性聚类为独立的SAP组。 >结果：我们在仰卧位期间识别出两组明显不同的女性；一个以SAP最初下降为特征，另一个显示为初始上升。脊髓麻醉后，第一组女性的平均SAP曲线显示血压下降，比其他女性更快。在两组妇女之间观察到心输出量的细微差异，第一组的平均心输出量曲线较高。 >结论：这项工作表明仰卧位会影响孕妇的临床相关心血管指标。一个简单的测试可以确定脊髓麻醉引起的低血压风险增加的患者。

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