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Relationship between changes in regional cerebral blood volume and oxygenation and changes in cardiac output and systemic vascular resistance during spinal anesthesia in women undergoing cesarean section

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A Letter to the Editor to this article was published on 26 November 2019

Abstract

Purpose

The decrease in maternal regional cerebral blood volume (rCBV) and oxygenation (rCBO) during spinal anesthesia for cesarean section depends on the severity of hypotension. We examined the relationships between changes in the systemic circulatory parameters, cardiac output (CO) and systemic vascular resistance (SVR), and rCBV and rCBO after induction of spinal anesthesia, evaluated by near-infrared spectroscopy (NIRS) and an arterial pressure-based cardiac output monitoring system (APCOs).

Methods

Seventeen patients undergoing elective cesarean section under spinal anesthesia were monitored every 1 min for mean arterial pressure (MAP), heart rate (HR), end-tidal carbon dioxide (EtCO2) and oxygen saturation (SpO2), and at 20 s intervals for CO, SVR, concentrations of oxy-hemoglobin (Hb), deoxy-Hb, total-Hb, and tissue oxygenation index (TOI), until 15 min after the intrathecal injection of bupivacaine. We investigated changes in the parameters from baseline and evaluated correlations between the changes in total-Hb and TOI and changes in CO and SVR, respectively, at the same timepoints.

Results

Oxy-Hb, total-Hb, TOI, and SVR significantly decreased and HR significantly increased with a decrease in MAP (P < 0.01). Deoxy-Hb, CO, SpO2, and EtCO2 levels did not change from baseline. There were statistically significant, although weak, positive correlations between both total-Hb and TOI with SVR (total-Hb; r = 0.18, P < 0.01, TOI; r = 0.38, P < 0.01).

Conclusion

The decreases in both rCBV and rCBO after induction of spinal anesthesia for cesarean section are probably dependent on the decrease in SVR due to spinal anesthesia.

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Acknowledgements

This work was supported by Grant-in-Aid for Young Scientists (B) (15K20061) of Japan society for the Promotion of Science.

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Authors and Affiliations

  1. Division of Anesthesiology, Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Yuko Kondo, Noriya Hirose, Takeshi Maeda & Takahiro Suzuki

  2. Department of Neurological Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Yuko Kondo, Takeshi Maeda & Atsuo Yoshino

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  1. Yuko Kondo
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  2. Noriya Hirose
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  3. Takeshi Maeda
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  4. Atsuo Yoshino
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  5. Takahiro Suzuki
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Correspondence to Noriya Hirose.

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Kondo, Y., Hirose, N., Maeda, T. et al. Relationship between changes in regional cerebral blood volume and oxygenation and changes in cardiac output and systemic vascular resistance during spinal anesthesia in women undergoing cesarean section. J Anesth 33, 579–586 (2019). https://doi.org/10.1007/s00540-019-02670-0

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