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＠Taichi Ando, Taiki Akasaka, Makoto Sumie, Kazuhiro Shirozu, Midoriko Higashi, Ken Yamaura, Prophylactic vasopressor and non-invasive cardiac output monitoring to prevent hypotension following spinal anesthesia for cesarean section: a randomized clinical trial, Euroanaesthesia 2023, 2023.06, Background and Goal of Study: Hypotension following spinal anesthesia during cesarean section is common and could negatively affect the mother and child. This study aimed to assess whether spinal anesthesia-induced hypotension could be prevented using non-invasive cardiac output monitoring and as needed prophylactic vasopressor therapy.
Materials and Methods: This prospective randomized study was approved by the Institutional Review Board of Kyushu University, Fukuoka, Japan (IRB No. 20192028), and registered in the UMIN-CTR Clinical Trial Database (ID: UMIN000040066; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000045678) on April 15, 2020. Two hundred patients undergoing elective cesarean delivery under spinal anesthesia between May 2020 and May 2022 were enrolled. Blood pressure (BP) was measured at 2.5-minute intervals following an intrathecal injection of 10 mg hyperbaric bupivacaine. When the systolic blood pressure (SBP) was under 100 mmHg and the mean BP was under 65 mmHg, or when the patient complained of nausea, a bolus of 100 µg phenylephrine was administered. Patients in the intervention group received 100 µg phenylephrine when the estimated continuous cardiac output (esCCO) decreased by over 10% since the last measurement. The primary outcome was the proportion of patients with hypotension (SBP under 100 mmHg and mean BP under 65 mmHg) between spinal anesthesia induction and delivery. The secondary outcomes were nausea and vomiting, reactive hypertension, and umbilical arterial blood pH. Fisher’s exact test and Student’s t-test were used for analysis.
Results and Discussion: Four of the 200 patients assessed for eligibility declined participation in this study, so 105 randomized to the esCCO group and 91 to the control group. Hemodynamic data for the primary outcome analysis were available from 102 subjects in the esCCO group and 89 in the control group. The incidence of hypotension was 44/89 (49%) in the control group and 20/102 (19%) in the intervention group (PConclusions: Estimated continuous cardiac output-guided prophylactic vasopressor therapy effectively prevented hypotension following spinal anesthesia for cesarean section.. |
