Tricuspid annular plane systolic excursion as a predictor of arterial hypotension induced by spinal anesthesia in cesarean section

Background: Severe hypotension is a common complication following spinal anesthesia in cesarean section surgery due to the combined effects of spinal anesthesia and the gravid uterus compressing the inferior vena cava. This study aimed to evaluate the role of tricuspid annular plane systolic excursion (TAPSE) in predicting hypotension after spinal anesthesia in cesarean sections. Methods: This observational study included 60 pregnant women aged 20 to 35 years with an American Society of Anesthesiologists physical status of Class I scheduled for elective cesarean section under spinal anesthesia who provided informed consent. Preoperative TAPSE was assessed using transthoracic echocardiography. Intraoperative hemodynamic parameters were recorded, with non-invasive blood pressure measurements taken every two minutes. Results: TAPSE was an important predictor of hypotension following spinal anesthesia with the optimal cut-off value being ≤2.59 cm, with a sensitivity of 66.7% and a specificity of 73.9%. Conclusions: A TAPSE value of ≤2.59 cm, measured preoperatively using transthoracic echocardiography, was predictive of intraoperative hypotension in this study. Preoperative TAPSE assessment shows promise for predicting intraoperative hypotension, optimizing fasting durations, and guiding fluid management. To ensure the accuracy of these findings, additional studies are needed. Clinical Trial Registration: The study was registered with ClinicalTrials.gov as NCT05874687, Date: 25 May 2023.