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OBSTETRIC ANESTHESIA

Using Heart Rate Variability to Stratify Risk of Obstetric Patients Undergoing Spinal Anesthesia

Dmitri Chamchad, MD^*, Valerie A. Arkoosh, MD^*, Jay C. Horrow, MD, MSstat^*, Jodie L. Buxbaum, MD^*, Igor Izrailtyan, MD, Lev Nakhamchik, MS, Dirk Hoyer, PhD, and J. Yasha Kresh, PhD

Departments of *Anesthesiology and Cardiovascular Medicine and Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania

Address correspondence to Jay C. Horrow, MD, MSstat, Mail Stop 310, 215 N. 15th St., Philadelphia, PA 19102-1192. Address e-mail to horrow{at}drexel.edu Reprints will not be available.

In this study, we evaluated whether point correlation dimension (PD2), a measure of heart rate variability, can predict hypotension accompanying spinal anesthesia for cesarean delivery. After the administration of spinal anesthesia with bupivacaine, hypotension was defined as systolic blood pressure 75% of baseline within 20 min of intrathecal injection. Using the median prespinal PD2 (3.90) to form 2 groups, LO and HI, all 11 hypotensive patients were in the LO group, and all 11 patients without hypotension were in the HI group. Baseline heart rate in the LO group was 95 bpm (10.2 SD), versus 81 bpm (9.6 SD) in the HI group. PD2 shows promise as a predictor of hypotension in pregnant women receiving spinal anesthesia.

IMPLICATIONS: The heart rate variability statistic peak point correlation dimension (PD2) successfully predicted hypotension within 20 min of spinal anesthesia in all 22 pregnant women undergoing cesarean delivery. If further research supports this finding, real-time electrocardiograph analysis of peak PD2 might prevent adverse circulatory events in these women.

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