Minimally Invasive Hemodynamic Assessment during Obstetric Hysterectomy for Invasive Placentation with Epidural Anesthesia

Figure 3

Effect size (Cohen’s d) assessment. The bold black line represents the changes (Cohen’s d) concerning the initial measurements; the differences between the time intervals are described in gray color. Cardiac index (a) undergoes small initial variations, secondary to vasodilation after epidural block and low variance afterward. At the end of the procedure, a moderate decrease in cardiac output was observed, which corresponds to the removal of the uterus from the systemic circulation. The cardiac work index (b) displayed more substantial changes at the end of the surgery. These fluctuations were followed by a mid-procedure stroke volume index adjustment (c). Despite these hemodynamic modifications, the stroke work index had (d) limited variation. Thus, we hypothesized that the noncardiac parts of the vascular system experience most of the adaptations, and the cardiac work investment is relatively the same for every stroke.

(a)

(b)

(c)

(d)