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Changes in the corrected carotid flow time can predict spinal anesthesia-induced hypotension in patients undergoing cesarean delivery: an observational study

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A Letter to the Editor to this article was published on 27 February 2024

A Letter to the Editor to this article was published on 24 February 2024

Abstract

Purpose

Spinal anesthesia is a standard technique for cesarean delivery; however, it possesses a risk of hypotension. We hypothesised that the changes in the corrected flow time induced by the Trendelenburg position could predict the incidence of hypotension after spinal anesthesia for cesarean delivery.

Methods

Patients undergoing elective cesarean delivery under spinal anesthesia were enrolled. Before anesthesia induction, corrected flow time was measured in the supine and Trendelenburg positions (FTc-1 and FTc-2, respectively). Additionally, a percent change in corrected flow time induced by the Trendelenburg position was defined as ΔFTc. The primary endpoint was to investigate the ability of ΔFTc to predict the incidence of spinal anesthesia-induced hypotension until delivery. The receiver operating characteristics curves to assess the ability of FTc-1, FTc-2, and ΔFTc to predict the incidence of hypotension were generated.

Results

Finally, 40 patients were included, and of those, 26 (65%) developed spinal anesthesia-induced hypotension. The areas under the curve for FTc-1, FTc-2, and ΔFTc were 0.591 (95% CI: 0.424 to 0.743) (P = 0.380), 0.742 (95% CI: 0.579 to 0.867) (P = 0.004), and 0.882 (95% CI: 0.740 to 0.962) (P < 0.001) respectively, indicating ΔFTc as the best predictor among these three parameters. The best threshold for ΔFTc was 6.4% (sensitivity: 80.8% (95% CI: 53.8 to 96.2), specificity: 85.7% (95% CI: 42.9 to 100.0)).

Conclusions

This study demonstrated that changes in the corrected carotid flow time induced by the Trendelenburg position could serve as a good predictor of spinal anesthesia-induced hypotension for cesarean delivery.

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Data availability

Data will be available upon reasonable request to corresponding author.

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Acknowledgements

We would like to thank Honyaku Center Inc. for English language editing.

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Authors and Affiliations

  1. Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, 1-5-7 Asahimachi, Abenoku, Osaka, 545-8586, Japan

    Takashi Juri, Koichi Suehiro, Shinta Yasuda, Aya Kimura, Yohei Fujimoto & Takashi Mori

Authors
  1. Takashi Juri
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  2. Koichi Suehiro
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  3. Shinta Yasuda
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  4. Aya Kimura
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  5. Yohei Fujimoto
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  6. Takashi Mori
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Correspondence to Koichi Suehiro.

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Conflict of interest

Koichi Suehiro has received speaker fees from Edwards Lifesciences and Otsuka Pharmaceutical Factory. Other authors have no conflict of interest.

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Supplementary Information

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540_2023_3293_MOESM1_ESM.pptx

Supplementary file1 Fig. 1. FTc-1: Corrected flow time in the supine position. FTc-2: Corrected flow time in the Trendelenburg position. Flow of the study. The flow time was measured in the supine and subsequently in the Trendelenburg position (15 degrees). (PPTX 47 KB)

Supplementary file2 Fig. 2. Doppler waveform in the carotid artery. Red arrows represent the flow time. (PPTX 105 KB)

540_2023_3293_MOESM3_ESM.pptx

Supplementary file3 Fig. 3. ΔFTc: Percent changes in the corrected flow time induced by the Trendelenburg position. a Correlation between ΔFTc and the duration of hypotension until delivery. b Correlation between ΔFTc and the number of doses of vasoactive drugs until delivery. (PPTX 66 KB)

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Juri, T., Suehiro, K., Yasuda, S. et al. Changes in the corrected carotid flow time can predict spinal anesthesia-induced hypotension in patients undergoing cesarean delivery: an observational study. J Anesth 38, 105–113 (2024). https://doi.org/10.1007/s00540-023-03293-2

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  • DOI: https://doi.org/10.1007/s00540-023-03293-2

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