Goal‐directed fluid therapy may improve hemodynamic stability in parturient women under combined spinal epidural anesthesia for cesarean section and newborn well‐being

Xiao, Wei; Duan, Qingfang; Zhao, Lei; Chi, Xin-Zuo; Wang, Fengying; Ma, Ding; Wang, Tianlong

doi:10.1111/jog.12769

Cited by 19 publications

(13 citation statements)

References 37 publications

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“…The study medicine was prepared in 50 mL syringes containing phenylephrine, norepinephrine, or placebo, marked with a randomization number. The dose of each medicine was calculated according to the participant's standard weight, defined as the actual height minus 110 cm [13], and then the medicine was diluted to 50 mL at different concentrations. The three groups were infused in the same speed at 20 ml/h.…”

Section: Randomization and Blindingmentioning

confidence: 99%

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: a randomized, double-blind, placebo-controlled study

et al. 2020

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Background Hypotension following spinal anesthesia (SA) during cesarean delivery (CD) occurs commonly and is related with maternal and fetal complications. Norepinephrine infusion is increasingly used for prevention of post-SA hypotension; however, its effects as compared to the traditional phenylephrine infusion remain unclear. This study aimed to compare the effects of phenylephrine and norepinephrine administered as continuous infusion during elective CD on maternal hemodynamic parameters and maternal and fetal outcomes. Methods This prospective, single-center, randomized, controlled study included 238 consecutive term parturients who underwent CD from February 2019 to October 2019. They were randomized to receive continuous infusion of 0.25 μg/kg/min phenylephrine, 0.05 μg/kg/min norepinephrine, or placebo. Hemodynamic monitoring was performed at 10 time points using LiDCOrapid. We analyzed umbilical vein (UV), umbilical artery (UA), and peripheral vein (PV) blood gas indexes and recorded intraoperative complications. Results In phenylephrine group, the systolic blood pressure (SBP) remain during the whole operation. Compared to the control group, phenylephrine, but not norepinephrine, significantly increased the systemic vascular resistance (SVR) to counteract the SA-induced vasodilatation, 3 min following norepinephrine/phenylephrine/LR administration (T4): 957.4 ± 590.3 vs 590.1 ± 273.7 (P < 0.000001); 5 min following norepinephrine/phenylephrine/LR administration (T5): 1104 ± 468.0 vs 789.4 ± 376.2 (P = 0.000002). at the time of incision (T6): 1084 ± 524.8 vs 825.2 ± 428.6 (P = 0.000188). Parturients in the phenylephrine group had significantly lower UV (1.91 ± 0.43) (P = 0.0003) and UA (2.05 ± 0.61) (P = 0.0038) lactate level compared to controls. Moreover, the UV pH value was higher in the phenylephrine than in the control group7.37 ± 0.03(P = 0.0013). Parturients had lower incidence of nausea, tachycardia, hypotension in phenylephrine group. Conclusions In this dataset, continuous phenylephrine infusion reduced the incidence of SA-induced hypotension, ameliorated SVR, while decreasing overall maternal complications. Phenylephrine infusions are considered the better choice during CD because of the significant benefit to the fetus. Trial registration Clinicaltrial.gov Registry, NCT03833895, Registered on 1 February 2019.

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Section: Randomization and Blindingmentioning

confidence: 99%

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: a randomized, double-blind, placebo-controlled study

et al. 2020

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“…The study medicine was prepared in 50 mL syringes containing phenylephrine, norepinephrine, or placebo, marked with a randomization number. The dose of each medicine was calculated according to the participant's standard weight, de ned as the actual height minus 110 cm 13 , and then the medicine was diluted to 50 mL at different concentrations. The three groups were infused in the same speed at 20ml/h.…”

Section: Randomization and Blindingmentioning

confidence: 99%

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: A randomized, double-blind, placebo-controlled study

Feng

Wang

Feng

et al. 2020

Preprint

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Background: Hypotension following spinal anesthesia (SA) during cesarean delivery (CD) occurs commonly and is related with maternal and fetal complications. Norepinephrine infusion is increasingly used for prevention of post-SA hypotension; however, its effects as compared to the traditional phenylephrine infusion remain unclear. This study aimed to compare the effects of phenylephrine and norepinephrine administered as continuous infusion during elective CD on maternal hemodynamic parameters and maternal and fetal outcomes.Methods: This prospective, single-center, randomized, controlled study included 238 consecutive term parturients who underwent CD from February 2019 to October 2019. They were randomized to receive continuous infusion of 0.25 μg/kg/min phenylephrine, 0.05 μg/kg/min norepinephrine, or placebo. Hemodynamic monitoring was performed at 10 time points using LiDCOrapid. We analyzed umbilical vein (UV), umbilical artery (UA), and peripheral vein (PV) blood gas indexes and recorded intraoperative complications.Results: In phenylephrine group, the systolic blood pressure (SBP) remain during the whole operation. Compared to the control group, phenylephrine, but not norepinephrine, significantly increased the systemic vascular resistance (SVR) to counteract the SA-induced vasodilatation, 3 min following norepinephrine/phenylephrine/LR administration (T4): 957.4±590.3 vs 590.1±273.7 (P<0.000001); 5 min following norepinephrine/phenylephrine/LR administration (T5): 1104±468.0 vs 789.4±376.2 (P=0.000002). at the time of incision (T6): 1084±524.8 vs 825.2± 428.6 (P=0.000188). Parturients in the phenylephrine group had significantly lower UV (1.91±0.43) (P=0.0003) and UA (2.05±0.61) (P=0.0038) lactate level compared to controls. Moreover, the UV pH value was higher in the phenylephrine than in the control group7.37±0.03(P=0.0013). Parturients had lower incidence of nausea, tachycardia, hypotension in phenylephrine group.Conclusions: In this dataset, continuous phenylephrine infusion reduced the incidence of SA-induced hypotension, ameliorated SVR, while decreasing overall maternal complications. Phenylephrine infusions are considered the better choice during CD because of the significant benefit to the fetus.Trial registration: Clinicaltrial.gov Registry, NCT03833895, Registered on 1 February 2019.

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“…Several studies have been performed using invasive and non‐invasive devices during Cesarean section, but none has compared a non‐invasive device to the current clinical standard of monitoring maternal hemodynamic parameters during high‐risk Cesarean section. Furthermore, most published studies have relied on percentage error or difference to evaluate or compare monitors, even though such a comparison is inappropriate when a gold‐standard invasive monitoring method is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Xiao et al . used LiDCOrapid to support goal‐directed fluid therapy during Cesarean section, in both a low‐risk cohort and a cohort of women with stable hypertensive disease.…”

Section: Discussionmentioning

confidence: 99%

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

Gutiérrez

Perry

Columb

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Maternal hemodynamics change significantly during Cesarean section complicated by massive hemorrhage or severe hypertensive disease. Cardiac output (CO) monitoring aids early, goal-directed hemodynamic therapy. The aim of this study was to record hemodynamic changes observed during Cesarean section in pregnancies at high risk of hemodynamic instability, using invasive (LiDCOrapid™) and non-invasive (NICOM ® ) devices, and to assess agreement between the two devices in measuring CO.Methods Simultaneous intraoperative hemodynamic measurements were taken using the LiDCOrapid and NICOM devices, following standardized techniques, in women at high risk of hemodynamic instability undergoing Cesarean section. Agreement in CO measurements between the two devices was assessed using Bland-Altman plots and the agreement:tolerability index (ATI). Agreement analyses were performed for repeated measures in subjects, using centiles.Results From 10 women, 307 paired measurements were analyzed. Mean bias (defined as the mean difference in CO measurements between the LiDCOrapid and NICOM devices) was 3.05 (95% CI, 1.89 to 4.21) L/min. Limits of agreement ranged from −1.58 (95% CI, −4.47 to −0.14) to 7.68 (95% CI, 6.24 to 10.56) L/min. The resulting agreement interval was 9.26 L/min which returned an ATI of 2.3. Conclusions There are large mean differences between CO measurements obtained during Cesarean section usingCorrespondence to: the LiDCOrapid and NICOM hemodynamic monitors in pregnant women at high risk of hemodynamic instability, indicating that they should not be considered interchangeable clinically. There is an unacceptably low level of agreement (ATI > 2) in CO measurements between the devices, conferring a high risk of clinical misclassification during massive hemorrhage. Copyright

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Goal‐directed fluid therapy may improve hemodynamic stability in parturient women under combined spinal epidural anesthesia for cesarean section and newborn well‐being

Abstract: LiDCOrapid -guided GDFT may provide benefit to healthy parturient women and their newborns.

Cited by 19 publications

References 37 publications

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: a randomized, double-blind, placebo-controlled study

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: a randomized, double-blind, placebo-controlled study

Effects of continuous infusion of phenylephrine vs. norepinephrine on parturients and fetuses under LiDCOrapid monitoring: A randomized, double-blind, placebo-controlled study

Cardiac output measurements during high‐risk Cesarean section using electrical bioreactance or arterial waveform analysis: assessment of agreement

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