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28.09.2018 | Original Article

Impact of non-invasive continuous blood pressure monitoring on maternal hypotension during cesarean delivery: a randomized-controlled study

verfasst von: Takashi Juri, Koichi Suehiro, Aya Kimura, Akira Mukai, Katsuaki Tanaka, Tokuhiro Yamada, Takashi Mori, Kiyonobu Nishikawa

Erschienen in: Journal of Anesthesia | Ausgabe 6/2018

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Abstract

Purpose

This study aimed to investigate the efficacy of the ClearSight™ system (Edwards Lifesciences, Irvine, CA) for reducing the incidence of hypotension compared with the traditional oscillometric blood pressure monitoring in cesarean delivery under spinal anesthesia.

Methods

Forty patients undergoing cesarean delivery under spinal anesthesia were enrolled. The patients were randomly divided into two groups (Control and ClearSight groups). All patients received spinal anesthesia using 0.5% hyperbaric bupivacaine (11.5 mg) and fentanyl (10 µg). Blood pressure was managed with the same protocol using the ClearSight™ system (ClearSight group) and oscillometric blood pressure monitoring (Control group). Furthermore, we compared the accuracy of the ClearSight™ system with the traditional oscillometric monitoring for blood pressure measurement using Bland–Altman, four-quadrant plot, and polar plot analyses.

Results

The incidence of hypotension was significantly lower in the ClearSight group from induction to delivery (45% vs. 0%, p < 0.001) and to the end of surgery (50% vs. 20%, p = 0.049). Intraoperative nausea occurred more frequently in the Control group (45% vs. 10%, p = 0.012). The ClearSight™ system demonstrated acceptable accuracy with a bias of − 4.3 ± 11.7 mmHg throughout the procedure. Four-quadrant analysis revealed an excellent trending ability of the ClearSight™ system with a concordance rate of approximately 95%. In the polar plot analysis, the angular bias and concordance rate were − 13.5° ± 19.0° and 76.9%, respectively.

Conclusions

The accuracy and trending ability of the ClearSight™ system for blood pressure measurement was clinically acceptable in cesarean delivery under spinal anesthesia, leading to reductions in maternal hypotension and nausea.

Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54:909–21.CrossRefPubMed

Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using? Curr Opin Anaesthesiol. 2006;19:238–43.CrossRefPubMed

Sng BL, Wang H, Assam PN, Sia AT. Assessment of an updated double-vasopressor automated system using Nexfin for the maintenance of haemodynamic stability to improve peri-operative outcome during spinal anaesthesia for caesarean section. Anaesthesia. 2015;70:691–8.CrossRefPubMed

Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology. 2002;97:1274–80.CrossRefPubMed

Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstet Gynecol. 2011;117:69–74.CrossRefPubMed

Butwick AJ, Columb MO, Carvalho B. Preventing spinal hypotension during caesarean delivery: what is the latest? Br J Anaesth. 2015;114:183–6.CrossRefPubMed

Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73:71–92.CrossRefPubMed

Bartels K, Esper SA, Thiele RH. Blood pressure monitoring for the anesthesiologist: a practical review. Anesth Analg. 2016;122:1866–79.CrossRefPubMed

Tsuchiya M, Takahashi R, Furukawa A, Suehiro K, Mizutani K, Nishikawa K. Transversus abdominis plane block in combination with general anesthesia provides better intraoperative hemodynamic control and quicker recovery than general anesthesia alone in high-risk abdominal surgery patients. Minerva Anestesiol. 2012;78:1241–7.PubMed

10.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefPubMed

11.

Myles PS, Cui J. Using the Bland–Altman method to measure agreement with repeated measures. Br J Anaesth. 2007;99:309–11.CrossRefPubMed

12.

Kim SH, Lilot M, Sidhu KS, Rinehart J, Yu Z, Canales C, Cannesson M. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology. 2014;120:1080–97.CrossRefPubMed

13.

Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth. 2011;25:536–46.CrossRefPubMed

14.

Suehiro K, Tanaka K, Yamada T, Matsuura T, Funao T, Mori T, Nishikawa K. The utility of intra-operative three-dimensional transoesophageal echocardiography for dynamic measurement of stroke volume. Anaesthesia. 2015;70:150–9.CrossRefPubMed

15.

Suehiro K, Tanaka K, Yamada T, Matsuura T, Mori T, Funao T, Nishikawa K. The ability of the Vigileo-FloTrac system to measure cardiac output and track cardiac output changes during one-lung ventilation. J Clin Monit Comput. 2015;29:333–9.CrossRefPubMed

16.

Okudaira S, Suzuki S. Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies. Arch Gynecol Obstet. 2005;271:292–5.CrossRefPubMed

17.

Mercier FJ, Diemunsch P, Ducloy-Bouthors AS, Mignon A, Fischler M, Malinovsky JM, Bolandard F, Aya AG, Raucoules-Aime M, Chassard D, Keita H, Rigouzzo A, Le Gouez A, Group CW. 6% hydroxyethyl starch (130/0.4) vs Ringer’s lactate preloading before spinal anaesthesia for caesarean delivery: the randomized, double-blind, multicentre CAESAR trial. Br J Anaesth. 2014;113:459–67.CrossRefPubMed

18.

Matsota P, Karakosta A, Pandazi A, Niokou D, Christodoulaki K, Kostopanagiotou G. The effect of 0.5 L 6% hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis. J Anesth. 2015;29:352–9.CrossRefPubMed

19.

Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2000;90:1390–5.CrossRefPubMed

20.

van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs. Int J Gynaecol Obstet. 1998;61:233–8.CrossRefPubMed

21.

Miyabe M, Sato S. The effect of head-down tilt position on arterial blood pressure after spinal anesthesia for cesarean delivery. Reg Anesth. 1997;22:239–42.CrossRefPubMed

22.

Qian XW, Chen XZ, Li DB. Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial. Int J Obstet Anesth. 2008;17:309–14.CrossRefPubMed

23.

Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH. Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology. 1994;80:326–37.CrossRefPubMed

24.

Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control. 2014;7:49–59.CrossRefPubMedPubMedCentral

25.

Lin FQ, Li C, Zhang LJ, Fu SK, Chen GQ, Yang XH, Zhu CY, Li Q. Effect of rapid plasma volume expansion during anesthesia induction on haemodynamics and oxygen balance in patients undergoing gastrointestinal surgery. Int J Med Sci. 2013;10:355–61.CrossRefPubMedPubMedCentral

26.

Hirose N, Kondo Y, Maeda T, Suzuki T, Yoshino A. Relationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section. J Anesth. 2016;30:603–9.CrossRefPubMed

27.

Meidert AS, Nold JS, Hornung R, Paulus AC, Zwißler B, Czerner S. The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: a randomised trial. Eur J Anaesthesiol. 2017;34:716–22.CrossRefPubMed

28.

Ilies C, Kiskalt H, Siedenhans D, Meybohm P, Steinfath M, Bein B, Hanss R. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. Br J Anaesth. 2012;109:413–9.CrossRefPubMed

29.

Akkermans J, Diepeveen M, Ganzevoort W, van Montfrans GA, Westerhof BE, Wolf H. Continuous non-invasive blood pressure monitoring, a validation study of Nexfin in a pregnant population. Hypertens Pregnancy. 2009;28:230–42.CrossRefPubMed

30.

Chen G, Chung E, Meng L, Alexander B, Vu T, Rinehart J, Cannesson M. Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management. J Clin Monit Comput. 2012;26:133–40.CrossRefPubMed

Titel: Impact of non-invasive continuous blood pressure monitoring on maternal hypotension during cesarean delivery: a randomized-controlled study
verfasst von: Takashi Juri
Koichi Suehiro
Aya Kimura
Akira Mukai
Katsuaki Tanaka
Tokuhiro Yamada
Takashi Mori
Kiyonobu Nishikawa
Publikationsdatum: 28.09.2018
Verlag: Springer Japan
Erschienen in: Journal of Anesthesia / Ausgabe 6/2018
Print ISSN: 0913-8668
Elektronische ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-018-2560-2

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Impact of non-invasive continuous blood pressure monitoring on maternal hypotension during cesarean delivery: a randomized-controlled study