title: 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.
abstract: 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.
authors: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.|Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors: B L
authors: BL
authors: Sng
authors: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.
authors: H
authors: H
authors: Wang
authors: Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore.|Singapore Clinical Research Institute, Singapore.
authors: P N
authors: PN
authors: Assam
authors: Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors: A T
authors: AT
authors: Sia
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal / Q000295:instrumentation* / Q000379:methods; D001331:Automation; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section / Q000295:instrumentation* / Q000379:methods; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy; D007231:Infant, Newborn; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D019990:Perioperative Care / Q000295:instrumentation* / Q000379:methods; D010656:Phenylephrine / Q000008:administration & dosage / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004809:Ephedrine