الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Spinal anesthesia for CS provides effective pain control, fast return to daily activities and avoidance of side effects related to general anesthesia, such as airway problems and the negative effects of intravenous anesthetic drugs on the fetus. Post-spinal hypotension is a common complication after spinal anesthesia specially for CS due to multiple factors as, hormonal changes, gravid uterus, and hypovolemia. The incidence of post-spinal hypotension varies according to its definition, but it reaches more than 70% in some studies. Post-spinal hypotension can negatively affect both mother and fetus. It can compromise uterine blood flow and fetal circulation, and thus cause fetal hypoxia and acidosis. Accurate prediction of post-spinal hypotension could enhance clinical decision-making, optimize management, and facilitate early intervention. More than thirty variables were used in the prediction of post-spinal hypotension including volume and fluid responsiveness indices. Ultrasound assessment of fluid status and non-invasive cardiometry are promising modalities used in prediction of post-spinal hypotension. Preanesthetic ultrasound carotid FTc was found to be a reliable indicator of post-spinal hypotension in cesarean section. Also, the baseline parameters obtained via the bioreactance-based system may serve as a predictor of postspinal anesthesia hypotension in parturients. In this study, we aim to evaluate two modalities for prediction and prevention of post-spinal hypotension by comparing ultrasound carotid FTc and electrical cardiometry in patients scheduled for elective cesarean section under spinal anesthesia. This randomized controlled study was carried out in Tanta University Hospitals after approval from ethical committee and informed written consent from each patient. This study included 300 full term women presented for elective cesarean section under spinal anesthesia in obstetric department of Tanta University Hospital. Patients included in the study were ASA classification II, aged more than 18 years with gestational age ≥ 36 weeks of pregnancy. Exclusion Criteria were, patient refusal to participate in the study, gestational age of ≥40 weeks of pregnancy, pregnancy-induced hypertension, diabetes, cardiovascular diseases, arrhythmia, antepartum hemorrhage, BMI above 36 kg/m2, or clinical fetal complications. Patients were randomly allocated to three equal groups. In group I (control), participants received standard of care with no intervention before spinal anesthesia. In group II (carotid US), ultrasound carotid FTc was used in patients included in this group to optimize the volume status before performing spinal anesthesia. FTc was calculated using Wodey`s formula. The FTc was measured three times, the mean of these values was used for analysis. After recording these data, a stress leg raising test was performed and the data was measured again. A difference in FTc >10% the patient was considered fluid responder and 500 ml crystalloids was infused. Reassessment was done till reaching FTc <10% before induction of spinal anesthesia. In group III (cardiometry), EC was used to optimize the volume status before performing spinal anesthesia. The SVV was measured. A SVV >10% was considered a fluid responder and 500 ml crystalloids was infused to the patient. Reassessment was done till reaching SVV <10% before induction of spinal anesthesia. Demographic data (age, BMI, and gestational age), surgical characteristics (duration of surgery and intraoperative blood loss), and fetal characteristics (umbilical cord PH and APGAR score) were insignificant between the three studied groups. Our results revealed significant decrease in the incidence of hypotension in carotid US and cardiometry groups as compared to control group with insignificant difference between carotid US and cardiometry groups. We found that the use of FTc and cardiometry SVV measurements can predict and reduce the incidence of post-spinal hypotension in women undergoing elective CS under spinal anesthesia. Also, our study showed that FTc can predict post spinal hypotension with sensitivity of 84.1% and specificity of 78.6%). The optimal cut-off value was 324.1 ms. Moreover, we found that cardiometry SVV can predict post spinal hypotension with sensitivity of 75.0% and specificity of 71.15%. The optimal cut-off value was 6%. In our study, the incidence of nausea and vomiting in control group was significantly higher than carotid US and cardiometry group. This finding may be associated with the higher incidence of hypotension in control group.