Use of an automated anesthesia information system to determine reference limits for vital signs during cesarean section

Franklin Dexter, Donald H. Penning, David Lubarsky, Elizabeth DeLong, Iain Sanderson, Bill C. Gilbert, Elizabeth Bell, J. G. Reves

Research output: Contribution to journalArticle

9 Scopus citations


Introduction. We evaluated whether automated anesthesia information systems can be used to calculate reference limits (popular-ion-based 'normal values') for vital signs. We considered four populations of women undergoing cesarean section: healthy under spinal anesthesia. healthy under general anesthesia, pre-eclamptic/eclamptic under spinal anesthesia, and pre-eclamytic/eclamptic under general anesthesia. Methods. Reference limits were calculated for each of the study populations by determination of percentiles for. minimum heart rate, maximum heart rate, minimum arterial oxyhemoglobin saturation (SaO 2), minimum mean arterial pressure (MAP), maximum MAP, decrease in MAP, and increase in MAP. Results. There was one adverse anesthetic outcome among the 1300 women in the study, the woman sustained a post-dural puncture headache. The 5th percentiles of SaO 2 were at least 95% saturation under spinal versus 90% under general. Under spinal anesthesia, 95th percentiles for decreases in MAP from baseline were 63 mmHg for healthy and 75 mmHg for pre-eclamptic/eclamptic women. Under general anesthesia, the 95th percentiles for maximum MAP were 161 and 177 mmHg, respectively. Two women of the 1300 patients experienced simultaneously a minimum SaO 2 < 92% and minimum MAP < 50 mmHg. Discussion. Automated anesthesia information systems can be used to determine reference limits for vital signs during anesthesia. Reference limits may play a role in malpractice cases when an expert claims that care by an anesthesiologist was sub-standard as shown by vital signs that were not maintained within the normal range during the critical portions of an anesthetic. Automated anesthesia information systems may enhance expert witnesses' clinical judgment.

Original languageEnglish (US)
Pages (from-to)491-498
Number of pages8
JournalJournal of Clinical Monitoring and Computing
Issue number7-8
StatePublished - Dec 1 1998
Externally publishedYes



  • Automated anesthesia information system
  • Cesarean section
  • Malpractice claim
  • Reference limit
  • Reference value

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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