Ability of Preoperative Carotid Artery Corrected Flow Time to Predict Hypotension and Postdural Puncture Headache During Cesarean Section
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 90
- 主要终点
- Predicting intraoperative hypotension using preoperative carotid artery corrected flow time (FTc).
研究概览
简要总结
Anesthesia for cesarean delivery can be provided through general or neuraxial anesthesia (spinal or epidural). Hypotension is a common complication of both methods. Hypotension associated with spinal anesthesia can cause dizziness, nausea, vomiting, restlessness, and confusion in the mother, while also decreasing blood flow to the baby, leading to hypoxia and fetal acidosis. Untreated persistent hypotension poses a life-threatening risk to both mother and baby.
In recent years, ultrasonography has become widely used to assess volume status. Carotid artery corrected flow time (FTc) is primarily affected by left ventricular preload and is related to myocardial contractility and afterload. Therefore, it can predict intraoperative hypotension.
Postdural puncture headache (PDPH) is a relatively common complication after neuraxial blocks. PDPH is generally defined as an orthostatic headache caused by low cerebrospinal fluid pressure accompanied by neck pain, tinnitus, hearing changes, photophobia, and/or nausea. Risk factors include female gender, young age, pregnancy, a previous history of PDPH, low CSF pressure, and low BMI.
This study will be conducted on pregnant women undergoing elective cesarean sections under spinal anesthesia in the cesarean operating room at Erciyes University Faculty of Medicine Hospital. The correlation between preoperative carotid artery FTc levels in pregnant women and the incidence of intraoperative hypotension and postoperative PDPH will be investigated, as will whether FTc levels are a significant predictor of the likelihood of developing intraoperative hypotension and postoperative PDPH. Carotid artery FTc will be measured 1 hour before surgery, and baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), peripheral oxygen saturation (SPO2), and heart rate will be recorded in the operating room. Values will be recorded at 1, 2, 3, 5, 10, 12, 15, and 30 minutes after spinal anesthesia. Patients will be assessed postoperatively for postdural puncture headache using a numerical rating scale (NRS) on days 2, 3, and 7.
This study is expected to demonstrate the ability of preoperative FTc to predict hypotension and PDPH, to determine the threshold value for predicting hypotension and PDPH, and to improve or modify the anesthesia method in patients with predicted hypotension and PDPH.
详细描述
Vaginal birth is a natural and physiological process. However, in certain circumstances, a cesarean section (CS) may be necessary to protect the health of the mother and baby.
Cesarean section anesthesia can be provided through general or neuraxial anesthesia (spinal or epidural). Hypotension is a common complication in both methods.
The incidence of hypotension associated with spinal anesthesia can be as high as 74% . This condition causes dizziness, nausea, vomiting, restlessness, and confusion in the mother, while also reducing blood flow to the baby, leading to hypoxia and fetal acidosis . Hypotension lasting longer than 2 minutes is associated with a significant increase in oxypurine and lipid peroxides in the umbilical cord, indicating ischemia-reperfusion injury . Hypotension lasting less than 2 minutes does not affect neurobehavioral outcomes, while maternal hypotension lasting longer than 4 minutes can be associated with neurobehavioral changes in the first 4 to 7 days of neonatal life. Untreated persistent hypotension poses a life-threatening risk to both mother and baby.
Mechanically, spinal anesthesia-mediated sympathetic blockade affects systemic vascular resistance (SVR) and induces peripheral blood pooling, resulting in a decrease in left ventricular preload, thus causing hypotension. Aortocaval compression contributes to further preload reduction. Collateral flow decreases after spinal anesthesia, leading to severe hypotension. Therefore, monitoring techniques to assess both preload and afterload can help predict the development of hypotension and guide appropriate prophylaxis in patients.
In recent years, ultrasonography has been widely used to assess volume status. Several studies have reported that corrected blood flow time (FTc) measured in the carotid artery can predict fluid responsiveness in spontaneously breathing patients. FTc is primarily affected by left ventricular preload and is related to myocardial contractility and afterload. Therefore, it can predict intraoperative hypotension.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 49 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •American Society of Anesthesiologists (ASA) Class II
- •Regular antenatal visits
- •Singleton pregnancy at ≥37 weeks' gestation
- •Pregnant women aged 18-49
排除标准
- •Patients with eclampsia or preeclampsia
- •Patients who have undergone emergency cesarean section
- •Patients with bleeding diatheses and those receiving anticoagulant therapy
- •Patients with a history of ≥50% carotid artery stenosis
- •Patients with cardiovascular disease
- •Hypertension
- •Patients with chronic obstructive pulmonary disease
- •Patients with a heart rhythm other than sinus rhythm
- •Patients with a history of cerebrovascular disease
- •Patients with alcoholism or psychiatric illness
- •Patients with placenta previa, accreta, or percreta
- •Patients with diabetes
结局指标
主要结局
Predicting intraoperative hypotension using preoperative carotid artery corrected flow time (FTc).
时间窗: perioperative period
次要结局
- Post-dural puncture headache is evaluated using Numerical Rating Scales (NRS) and its relationship with preoperative corrected carotid artery flow time (FTc) is determined.(postoperative 2, 3, 7 days)
研究者
Aynur Akın
professor doctor
TC Erciyes University