Skip Navigation



BJA Advance Access published online on October 28, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei266
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
96/1/100    most recent
aei266v1
Right arrow E-Letters: Submit a response to the article
Right arrow E-letters: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Sharwood-Smith, G.
Right arrow Articles by Drummond, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sharwood-Smith, G.
Right arrow Articles by Drummond, G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted September 24, 2005

Clinical Investigation

Assessment of pulse transit time to indicate cardiovascular changes during obstetric spinal anaesthesia{dagger}

G. Sharwood-Smith 1*, J. Bruce 1, and G. Drummond 1

1 Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SU, UK

* To whom correspondence should be addressed.
G. Sharwood-Smith, E-mail: gssmith{at}staffmail.ed.ac.uk


  Abstract

Background. Pulse transit time (PTT) measurement may provide rapidly available beat-to-beat cardiovascular information when conditions change quickly and routine invasive arterial pressure measurement is not justified, for example during obstetric spinal anaesthesia.

Method. We obtained ethics approval for an observational study of PTT during the onset of spinal anaesthesia in patients having elective or urgent Caesarean section. PTT was measured as the difference in time between the peak of the ECG R wave and the upstroke of the toe plethysmograph. Arterial pressure was measured by non-invasive sphygmomanometry.

Results. We analysed data from 58 normotensive patients and 15 patients with pregnancy-induced hypertension (PIH). PTT increased with the onset of spinal anaesthesia as arterial pressure decreased. An increase of 20% in PTT was 74% sensitive and 70% specific in indicating a decrease in mean arterial pressure of more than 10%. Changes in PTT were related to changes in mean arterial pressure (r2=0.55, P<0.0001). Arterial pressure changes were greater and PTT increased significantly more quickly in the normotensive patients than in the patients with hypertension [median, quartiles: 32 (14, 56) ms min-1 compared with 7 (6, 18) ms min-1; P<0.01, Mann-Whitney U-test]. However, the relationship between PTT and arterial pressure was similar for the normotensive patients and the patients with PIH.

Conclusion. PTT measurement gave a beat-to-beat indication of arterial pressure during spinal anaesthesia, and could be developed to allow prediction of the onset of hypotension.

Keywords: anaesthesia, obstetric; anaesthetic techniques, regional, spinal; cardiovascular system; monitoring, pulse transit time; pregnancy.
{dagger}Data from this study were presented in part at the Obstetric Anaesthetists Association Meeting at Nottingham, UK, on May 10, 2002 and at the 13th World Congress of the International Society for the Study of Hypertension in Pregnancy at Toronto, Canada, on June 2, 2002.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


E-letters:

Read all E-letters

Response to Assessment of pulse transit time to indicate cardiovascular changes during obstetric spi
Andrew RM Conway Morris
British Journal of Anaesthesia, 3 Feb 2006 [Full text]
Re: Response to Assessment of pulse transit time to indicate cardiovascular changes during obstetric
Gordon B Drummond, et al.
British Journal of Anaesthesia, 10 Feb 2006 [Full text]
Assessment of pulse transit time to indicate cardiovascular changes during obstetric spinal anaesthe
Rupert A Payne, et al.
British Journal of Anaesthesia, 13 Feb 2006 [Full text]
Response to Payne, Webb and Maxwell: an indicator, yes; a measure, no.
Gordon B Drummond, et al.
British Journal of Anaesthesia, 19 Feb 2006 [Full text]
Re: Response to Payne, Webb and Maxwell: an indicator, yes; a measure, no.
Rupert A Payne, et al.
British Journal of Anaesthesia, 7 Mar 2006 [Full text]

Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.