Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

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

doi:10.4103/0366-6999.160546

Cited by 11 publications

(7 citation statements)

References 53 publications

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“…We administered epidural analgesia to our patients in order to avoid the side effects of systemically administered opioids, such as nausea and vomiting, urinary retention, pruritus, and respiratory depression, and to reduce the postoperative antiinflammatory response [24][25]. CSE anesthesia was preferred in our study because it combines the advantages of spinal anesthesia (rapid onset, minimal toxic effects, high efficacy) and epidural anesthesia (lengthening the duration of anesthesia), partially reduces their disadvantages, and allows for postoperative analgesia [15,[25][26][27][28]. However, we waited 90 min after the spinal block so that the effects of the spinal bupivacaine had passed before performing our postoperative objective analyses in all 3 groups.…”

Section: Discussionmentioning

confidence: 99%

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

et al. 2020

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This study was conducted after obtaining Ethics Committee approval from the İnönü University Medical Faculty (2015/171) and informed consent from all of the Background/aim: The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections.Materials and methods: Eighty-one pregnant women, aged 18-45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 μg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively.Results: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions: The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.

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Section: Discussionmentioning

confidence: 99%

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

et al. 2020

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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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“…The PulseCO algorithm that was used in analysis of arterial pressure curve by LiDCORapid monitor, has been validated and used in healthy, pregnant patients receiving spinal anaesthesia. (66,67) The absolute value of CI measured with this method has been controversial, however its value for monitoring the trends in CI values has been validated and accepted, also in spinal anaesthesia. (30,63,68) We were aware of the limitations of the method used in the assessment of absolute values of CI; also in SVRI calculations the mean atrial pressure was not measured but arbitrarily set to 7 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Goal-directed Fluid Therapy May Improve Hemodynamic Stability of Parturient with Hypertensive Disorders of Pregnancy Under Combined Spinal Epidural Anesthesia for Cesarean Delivery and the Well-being of Newborns

Cited by 11 publications

References 53 publications

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

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

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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