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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
Author(s) -
Sng B. L.,
Wang H.,
Assam P. N.,
Sia A. T.
Publication year - 2015
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.13008
Subject(s) - ephedrine , medicine , phenylephrine , blood pressure , anesthesia , heart rate , hemodynamics , caesarean section , levobupivacaine , pregnancy , bupivacaine , biology , genetics
Summary Hypotension occurs commonly during spinal anaesthesia for caesarean section, associated with maternal and fetal adverse effects. We developed a double‐vasopressor automated system with a two‐step algorithm and continuous non‐invasive haemodynamic monitoring using the Nexfin ™ device. The system delivered 25 μg phenylephrine every 30 s when systolic blood pressure was between 90% and 100% of baseline, or 2 mg ephedrine at this blood pressure range and heart rate < 60 beats.min −1 ; and 50 μg phenylephrine or 4 mg ephedrine when systolic blood pressure was < 90% of baseline with the same heart rate criterion. Fifty‐seven women received standardised spinal anaesthesia. Twenty‐seven (47.4%) had at least one reading of hypotension defined as systolic blood pressure < 80% baseline. Systolic blood pressure was within 20% of the baseline in a mean ( SD ) of 79.8 (20.9)% of measurements. Fifty‐three (93.0%) women required phenylephrine before delivery while 10 (17.5%) required ephedrine. Six women (10.5%) experienced nausea and three (5.3%) vomited. The system was able to achieve a low incidence of maternal hypotension with good maternal and fetal outcomes.