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Closed-loop double-vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: a preliminary study.
Anaesthesia 2012; 67(12):1348-55A

Abstract

Hypotension occurs in most caesarean sections under spinal anaesthesia, necessitating vasopressor administration. However, the optimal dosing regimen remains unclear. We have developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive blood pressure monitoring. This prospective cohort study recruited 55 healthy women under standardised spinal anaesthesia with 2.2 ml hyperbaric bupivacaine 0.5%, 15 μg fentanyl and 100 μg morphine. A 50-μg phenylephrine bolus was given at 1-min intervals when systolic blood pressure fell below 90% of baseline, and a 4-mg ephedrine bolus was given when hypotension developed with bradycardia (heart rate <60 beats.min(-1)). Systolic blood pressure was within 20% of baseline in 88% of all measurements. Six patients (11%) had one or more measurements above 120% of baseline (1% of all measurements), whereas 36 (65%) had at least one reading below 80% of baseline (11% of total measurements). The system maintained systolic blood pressure at a mean (SD) of -9.1 (7.0)% below baseline, with 5.4 (2.5)% fluctuation. Two patients (4%) experienced pre-delivery nausea. All 5-min Apgar scores were 9.

Authors+Show Affiliations

Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23020653

Citation

Sia, A T H., et al. "Closed-loop Double-vasopressor Automated System to Treat Hypotension During Spinal Anaesthesia for Caesarean Section: a Preliminary Study." Anaesthesia, vol. 67, no. 12, 2012, pp. 1348-55.
Sia AT, Tan HS, Sng BL. Closed-loop double-vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: a preliminary study. Anaesthesia. 2012;67(12):1348-55.
Sia, A. T., Tan, H. S., & Sng, B. L. (2012). Closed-loop double-vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: a preliminary study. Anaesthesia, 67(12), pp. 1348-55. doi:10.1111/anae.12000.
Sia AT, Tan HS, Sng BL. Closed-loop Double-vasopressor Automated System to Treat Hypotension During Spinal Anaesthesia for Caesarean Section: a Preliminary Study. Anaesthesia. 2012;67(12):1348-55. PubMed PMID: 23020653.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Closed-loop double-vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section: a preliminary study. AU - Sia,A T H, AU - Tan,H S, AU - Sng,B L, Y1 - 2012/09/28/ PY - 2012/10/2/entrez PY - 2012/10/2/pubmed PY - 2013/1/18/medline SP - 1348 EP - 55 JF - Anaesthesia JO - Anaesthesia VL - 67 IS - 12 N2 - Hypotension occurs in most caesarean sections under spinal anaesthesia, necessitating vasopressor administration. However, the optimal dosing regimen remains unclear. We have developed a novel vasopressor delivery system that automatically administers phenylephrine or ephedrine based on continuous non-invasive blood pressure monitoring. This prospective cohort study recruited 55 healthy women under standardised spinal anaesthesia with 2.2 ml hyperbaric bupivacaine 0.5%, 15 μg fentanyl and 100 μg morphine. A 50-μg phenylephrine bolus was given at 1-min intervals when systolic blood pressure fell below 90% of baseline, and a 4-mg ephedrine bolus was given when hypotension developed with bradycardia (heart rate <60 beats.min(-1)). Systolic blood pressure was within 20% of baseline in 88% of all measurements. Six patients (11%) had one or more measurements above 120% of baseline (1% of all measurements), whereas 36 (65%) had at least one reading below 80% of baseline (11% of total measurements). The system maintained systolic blood pressure at a mean (SD) of -9.1 (7.0)% below baseline, with 5.4 (2.5)% fluctuation. Two patients (4%) experienced pre-delivery nausea. All 5-min Apgar scores were 9. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/23020653/Closed_loop_double_vasopressor_automated_system_to_treat_hypotension_during_spinal_anaesthesia_for_caesarean_section:_a_preliminary_study_ L2 - https://doi.org/10.1111/anae.12000 DB - PRIME DP - Unbound Medicine ER -