Heart Rate Variability as a Predictor of Hypotension Following Spinal for Elective Caesarean Section: A Prospective Observational Study

(Anaesthesia. 2017;72(5):603–608) Hypotension after spinal anesthesia for cesarean delivery is a significant complication that can adversely affect both the mother and her unborn child. In fact, in South Africa a majority of anesthesia-related maternal deaths occur in women receiving spinal anesthesia with >50% associated with spinal-induced hypotension. Therefore, a method to predict preoperatively which patients will experience this complication would be highly desirable, with the potential to alter patient management and improve outcomes. Previous studies have found that heart rate variability (HRV) analysis, which serves as a measure of autonomic function, can predict spinal-induced hypotension in parturients. In this prospective observational study from South Africa, HRV was evaluated in comparison to other potential predictors of hypotension [baseline heart rate and body mass index (BMI)] in women undergoing elective cesarean section under spinal anesthesia.