Femoral artery Doppler as a novel predictor of spinal hypotension in elective cesarean delivery cases: a prospective observational study

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-06-18 DOI:10.1016/j.ijoa.2025.104706

M.A. Helmy , K.A. Helmy , R.A. Kaddah , M.A. Shamma , M.A. Ali , L.M. Milad

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引用次数: 0

Abstract

Background

Spinal anesthesia is the preferred anesthetic for elective cesarean deliveries, though spinal hypotension requires prophylactic intervention to avoid serious complications. Several parameters have been studied to predict spinal hypotension; however, no reliable predictor has been identified to date. Spinal anesthesia induces femoral artery vasodilatation that induces flow velocity changes. Therefore, our study aimed to evaluate whether changes in femoral artery Doppler indices could serve as predictors of spinal hypotension.

Methods

This prospective observational study included pregnant women undergoing elective cesarean delivery. Spinal hypotension was defined as a reduction of systolic blood pressure of >20 % of the baseline value. All patients received a co-load of lactated Ringer’s 200 mL over 10 minutes, and a prophylactic infusion of noradrenaline 0.08 µg/kg/min. An experienced operator performed Doppler examinations of the right common femoral artery before, immediately after, at two, and five minutes after spinal anesthesia. Pulsatility and resistive indices were calculated using built-in software. A receiver operating characteristic curve analysis was performed to assess the accuracy of Doppler indices in predicting spinal hypotension. The primary outcome variable was the accuracy of the change in pulsatility index in predicting spinal hypotension.

Results

Forty patients were included in the study. Patients with hypotension (n=13) showed higher baseline Pulsatility index, shock index, change in pulsatility index, change in resistive index, and change in waveform morphology. Doppler indices showed a good predictive ability for predicting spinal hypotension. The AUC (95% CI) for change in pulsatility index and resistive index to predict spinal hypotension were 0.99 (0.90–1.00) and 0.96 (0.85–1.00), respectively. In addition, the best cut-off values for the change in pulsatility and resistive indices to predict spinal hypotension were >10.6% and 12%, respectively.

Conclusion

Our findings in women undergoing scheduled cesarean delivery under spinal anesthesia and prophylactic norepinephrine infusion show that changes in the femoral artery Doppler indices, specifically pulsatility index, resistive index, and waveform morphology, may predict spinal hypotension. Absent morphological changes after spinal anesthesia can rule out spinal hypotension, with a 100% negative predictive value.

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股动脉多普勒作为选择性剖宫产病例脊柱低血压的新预测指标：一项前瞻性观察研究

背景：脊髓麻醉是选择性剖宫产的首选麻醉，但脊髓低血压需要预防性干预以避免严重并发症。研究了几个参数来预测脊柱低血压；然而，迄今为止还没有确定可靠的预测指标。脊髓麻醉诱导股动脉血管扩张，引起血流速度变化。因此，我们的研究旨在评估股动脉多普勒指数的变化是否可以作为脊髓低血压的预测指标。方法本前瞻性观察研究纳入择期剖宫产孕妇。脊柱低血压被定义为收缩压降低基线值的20%。所有患者均在10分钟内服用乳酸林格氏液200 mL，预防性输注去甲肾上腺素0.08µg/kg/min。一位经验丰富的操作员在脊髓麻醉前、后、2分钟和5分钟对右股总动脉进行了多普勒检查。利用内置软件计算脉搏和电阻指数。采用受试者工作特征曲线分析来评估多普勒指数预测脊柱低血压的准确性。主要结局变量是脉搏指数变化预测脊柱低血压的准确性。结果共纳入40例患者。低血压患者（n=13）基线脉搏指数、休克指数、脉搏指数变化、电阻指数变化、波形形态变化较高。多普勒指数对脊柱低血压有较好的预测能力。脉搏指数和阻力指数变化预测脊柱低血压的AUC （95% CI）分别为0.99（0.90-1.00）和0.96（0.85-1.00）。此外，脉搏和阻力指数变化预测脊柱低血压的最佳临界值分别为10.6%和12%。结论在脊髓麻醉和预防性去甲肾上腺素输注的剖宫产妇女中，我们的研究结果表明，股动脉多普勒指数的变化，特别是脉搏指数、阻力指数和波形形态的变化可能预测脊柱低血压。脊髓麻醉后无形态学改变可排除脊髓低血压，阴性预测值为100%。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.