ESRA19-0658\u2005Continuous non-invasive haemodynamic monitoring during caesarean section in hypertensive patients

Abstract

Background and aims Hypertensive derangements, preeclampia included, complicate 8–10% of pregnancies worldwide and represent a major cause of maternal and foetal morbidity and mortality. Preeclamptic patients are often hypovolemic and oedematous with increased SVR, low CO and variable degree of left ventricular hypertrophy and dysfunction. In these patients, the haemodynamic variations induced by loco-regional anesthesia (LRA) during caesarean section (CS), despite common, may be unpredictable and risky. Objectives: Observational study aimed to evaluate the haemodynamic effects of LRA in preeclamptic and hypertensive patients. Methods Pregnant (18–40 y) and informed women, single fetus, gestational age >31w, ASA II or ASA III, elective or urgent CS under LRA. Monitoring: Clear-sight® finger cuff (Edwards Lifescience). Hemodynamic parameters:cardiac output (CO), cardiac index (CI), systolic, diastolic and mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), stroke volume(SV),stroke volume index(SVI),stroke volume variation(SVV).Waypoints: baseline, left lateral decubitus, LRA, skin incision, fetal extraction, afterbirth. Results 10 preeclamptic patients (PE, 5 early and 5 late preeclampsia), 5 hypertensive patients (HT) and 22 controls (C). No statistically significant differences for preoperative data (age, weight, height, comorbidities, chronic therapy) were found, except hypertension and hypertensive drugs. Hemodynamic parameters varied during surgery within all groups, being pathological from the beginning in PE and HT patients; pressure followed physiological and LRA-induced changes, PE and HT pts maintained higher PAM than controls; CI downward variation was higher in PE than in HT, with a 25% increase in C and HT patients after LRA nadir; non compensatory HR increase was witnessed in PE patients; SVI variation pattern was group specific after LRA maximal effect. Conclusions Pathological pregnancy is characterized by a heterogenous response to LRA. Preeclampsia may not be treated as hypertension.