ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1647102
Feasibility of continuous high-resolution bioreactance monitoring during cesarean delivery under spinal anesthesia
Provisionally accepted
- 1Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
- 2Philipps-Universitat Marburg, Marburg, Germany
- 3Department of Obstetrics and Perinatal Medicine, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany
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Purpose This study is the first to apply bioreactance-based hemodynamic monitoring with a 4-second interval during cesarean delivery under spinal anesthesia. We evaluated the feasibility of continuous, high-resolution perioperative monitoring in a routine clinical setting, with a particular focus on the temporal relationship between hypotension and changes in advanced hemodynamic parameters. Methods This prospective observational study conducted between December 2023 and April 2024 included 51 healthy parturients scheduled for elective cesarean delivery under spinal anesthesia were included. All participants underwent continuous non-invasive hemodynamic monitoring using bioreactance technology. Hemodynamic parameters were recorded at 4-second intervals. The primary outcome was the relative change in the stroke volume index (SVI) from baseline. The secondary endpoints included signal quality, data integrity, and trends in hemodynamic parameters. Results A reduction in the stroke volume index (SVI) of ≥20% was observed in 29 of 51 patients. The median percentage change in SVI from baseline was −18.9% [IQR −31.5 to −6.1]; p<0.001. The median time from the onset of relevant SVI decline to the occurrence of hypotension was 2:20 minutes [IQR 1:16 – 3:56]. The total cumulative observation time for all patients was 3,781 minutes. At a 4-second sampling interval, approximately 56,713 data points per hemodynamic parameter were expected. The signal loss was minimal, with less than 0.5% missing data per parameter. Conclusions This method proved to be feasible and yielded stable, high-resolution hemodynamic data. Among all parameters, the SVI showed the most consistent baseline values prior to anesthesia. It also demonstrated the most pronounced change, with a statistically significant decline in the majority of subjects between spinal anesthesia and the onset of first hypotension. In such cases, the marked decline in SVI may serve as an early indicator of impending hemodynamic compromise. These results from a low-risk obstetric cohort may inform future research on high-risk populations.
Keywords: Bioreactance technology, Cesarean delivery, Hypotension, spinal anesthesia, Stroke volume index
Received: 14 Jun 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Gaik, Bahle, Keil, Wulf and Vojnar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Benjamin Vojnar, vojnar@med.uni-marburg.de
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