Noninvasive Hemodynamic Assessment with Impedance Cardiography During Spinal and Epidural Anesthesia in Obstetrics

Łukasz Czyżewski; Małgorzata Juda; Justyna Teliga-Czajkowska; Janusz Wyzgał; Janusz Sierdziński; Andrzej Silczuk; Łukasz Dudziński

doi:10.3390/jcm15010074

Noninvasive Hemodynamic Assessment with Impedance Cardiography During Spinal and Epidural Anesthesia in Obstetrics

J Clin Med. 2025 Dec 22;15(1):74. doi: 10.3390/jcm15010074.

Authors

Łukasz Czyżewski¹, Małgorzata Juda², Justyna Teliga-Czajkowska³, Janusz Wyzgał⁴, Janusz Sierdziński⁵, Andrzej Silczuk⁶, Łukasz Dudziński⁷

Affiliations

¹ Department of Geriatric Nursing, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland.
² Institute of Nursing, Faculty of Health Sciences and Psychology, Collegium Medicum, University of Rzeszow, 35-310 Rzeszow, Poland.
³ Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland.
⁴ Department of Nephrology Nursing, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland.
⁵ Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 00-581 Warsaw, Poland.
⁶ Department of Community Psychiatry, Medical University of Warsaw, 02-353 Warsaw, Poland.
⁷ Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland.

Abstract

Background/Objectives: Spinal anesthesia (SA) for cesarean section and epidural analgesia (EA) for vaginal delivery induce hemodynamic changes that may compromise maternal and fetal safety. In this observational, hypothesis-generating study, we used impedance cardiography (ICG) to characterize maternal hemodynamic responses to EA for labor versus SA for cesarean delivery and to describe hemodynamic profiles associated with commonly used local anesthetic and vasopressor regimens. Methods: In this observational study, 132 women at term were included (52 with epidural analgesia (EA), 80 with spinal anesthesia (SA)). Hemodynamic parameters were measured using the ICON electrical cardiometry monitor (Osypka Medical GmbH). ICON and oscillometric blood pressure (BP) monitoring captured cardiac index (CI), stroke volume (SV), heart rate (HR), systemic vascular resistance index (SVRI), and thoracic fluid content (TFC) at T0 (baseline), approximately 5 and approximately 10 min, skin incision, delivery, and oxytocin administration. Results: CI remained stable and comparable between EA and SA (3.9 ± 0.6 vs. 3.9 ± 0.6 L/min/m²; p = 0.530). SV was higher in EA (85.1 ± 11.3 vs. 78.1 ± 9.7 mL; p < 0.001), whereas HR was higher in SA (92.2 ± 12.9 vs. 85.8 ± 12.5 bpm; p = 0.009). In EA, ropivacaine and bupivacaine showed similar hemodynamic profiles. Within the SA cohort, women managed with phenylephrine infusion had lower CI and HR but higher MAP and SVRI compared with those receiving ephedrine boluses, consistent with the expected pharmacodynamic profiles of these agents. Conclusions: ICG was feasible and provided dynamic, noninvasive estimates of maternal cardiovascular adaptation during obstetric anesthesia. In this non-randomized, exploratory cohort, descriptive differences in hemodynamic profiles between vasopressor strategies were more pronounced than between local anesthetics. Phenylephrine-based management showed a pattern of higher BP and SVRI but lower CI and HR, whereas ephedrine-based management tended to preserve CI through chronotropic effects.

Keywords: cardiac index; ephedrine; epidural analgesia; hemodynamics; impedance cardiography; obstetric anesthesia; phenylephrine; spinal anesthesia; stroke volume; vasopressor strategy.