BACKGROUND:
An inconsistency of hypotension detection in women undergoing cesarean section with use of standard intermittent blood pressure monitoring versus with use of a continuous non-invasive arterial pressure device post spinal anesthetic has been previously noted (1). Although hypotension was significantly more often detected while utilizing continuous non-invasive monitoring, no associated study has evaluated the potential clinical implications regarding the total hemodynamic management between these two modalities.
OBJECTIVE:
Evaluate the clinical management of patients undergoing cesarean section with regard to fluid and pressor administration in the setting of intermittent vs continuous non-invasive blood pressure monitoring.
METHODS:
A total of 56 singleton parturients undergoing cesarean section under a spinal anesthetic were included in the study analysis. Blood pressure of one group of 28 subjects were assessed via a standard intermittent blood pressure cuff, while the other 28 subjects were assessed via a continuous non-invasive blood pressure device. No specific protocol for fluid management was utilized. Fluid administration (crystalloid and colloid), fluid equivalence administration based upon a conventional 3:1 colloid to crystalloid ratio, estimated blood loss (EBL), urine output (UOP), and vasoactive medication use (phenylephrine and ephedrine) were compared between the two groups.
RESULTS:
Total volume loss were non-significant between groups. No significant differences were identified between total fluid administration, fluid equivalence administration, and total vasoactive medication use.
CONCLUSIONS:
Although continuous arterial pressure monitoring may detect hypotensive episodes more often than a traditional blood pressure cuff, our study suggests that no total hemodynamic management changes are demonstrated throughout an entire cesarean delivery when comparing the two.
REFERENCES:
C. Ilies, H. Kiskalt, D. Siedenhans, P. Meybohm, M. Steinfath, B. Bein, R. Hanss. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. Br J Anaesth. 2012 Sep; 109(3): 413–419.
