The effects of continuous noninvasive arterial pressure monitoring on preventing maternal and neonatal outcomes from hypotension after combined spinal-epidural anesthesia in cesarean delivery:a single-center,prospective,randomized controlled trial
Objective To assess the impact of continuous noninvasive arterial blood pressure monitoring(CNAP)on maternal and neonatal outcomes during cesarean section under combined spinal-epidural anesthesia(CSEA),as compared to the conventional noninvasive cuff arterial pressure(NCAP).Methods In a prospective,randomized controlled clinical trial conducted from January to June 2024 at Shunde Hospital of Southern Medical University,we enrolled 284 eligible parturients scheduled for elective cesarean delivery under CSEA.Participants were randomly assigned to two groups,with 142 parturients in each.Due to factors such as movement,shivering,or other reasons,14 parturients were excluded from the study.The final analysis included 139 parturients in the NCAP group and 131 in the CNAP group.NCAP group,blood pressure was monitored using an intermittent cuff during the procedure,with measurements taken at 3-minute intervals;CNAP group:blood pressure was continuously monitored using CNAP.When systolic blood pressure(SBP)fell below 80%of the baseline value or mean arterial pressure(MAP)dropped below 65 mmHg,hypotension was promptly treated with an intravenous bolus of norepinephrine at a dose of 6-10 µg,with additional doses administered as necessary based on the patient's blood pressure response.At each time point,we recorded hemodynamic changes,the requirement for norepinephrine administration,maternal adverse effects,fetal umbilical artery flow indices,and the results of neonatal umbilical artery blood gas analysis.Results Compared with the NCAP group,the CNAP group detected hypotension at an earlier stage(P=0.008)and exhibited a higher rate of hypotension detection(P=0.024).Owing to the CNAP group's earlier and more frequent detection of hypotension,which allowed for timely intervention to prevent further blood pressure drops,the incidence of severe maternal hypotension was significantly reduced(P=0.005).Additionally,the median dose of norepinephrine required(P=0.014)and the frequency of its administration(P=0.012)were higher in the CNAP group.SBP was significantly higher in the CNAP group compared to the NCAP group from the 4th to the 28th minute following anesthesia induction(P<0.05).Additionally,the CNAP group exhibited a lower incidence of hypotension at multiple time points after anesthesia(specifically at 7,10,13,16,19,22,25 min)compared to the NCAP group(P<0.05).The incidence of maternal nausea and vomiting was significantly lower in the CNAP group compared to the NCAP group(P=0.017).The fetal umbilical artery's peak systolic peak velocity/diastolic velocity(S/D),resistance index(RI),and pulsatility index(PI)were all elevated compared to pre-anesthesia values,with a more pronounced increase observed in the NCAP group than in the CNAP group at 3 minutes post-anesthesia induction(P<0.001).However,for mothers with MAP below 60 mmHg,the neonatal umbilical arterial blood gas pH was significantly lower in the NCAP group compared to the CNAP group(P=0.026).There were no significant differences between the two groups in the fetal umbilical artery S/D ratio,RI,PI,neonatal Apgar score and umbilical artery blood gas pH,BE,PaO2,and PaCO2 at 6 minutes post-anesthesia(P>0.05).Conclusion CNAP significantly augments anesthesiologists'ability to swiftly detect and manage hemodynamic fluctuations by providing continuous real-time monitoring of maternal blood pressure.This proactive surveillance results in a decreased incidence of intraoperative maternal hypotension,which in turn enhances the safety of surgical procedures and patient comfort.Additionally,it mitigates the risk of neonatal acidosis,contributing to improved perinatal outcomes.
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