The Use Of Continuous Cardiac Output Monitoring In Patients With Supine Hypotensive Syndrome Undergoing Cesarean Delivery

Background: We aim to determine the hypothesis that anesthesia management based on continuous hemodynamic monitoring without posture adjustment,could make it more comfortable for patients with SHS and optimize the neonatal acid-base equilibrium.Methods: In this single-center prospective randomized controlled study,a total of 60 patients with term pregnancies from Shengjing Hospital of China Medical University who were to undergo elective cesarean delivery under combined spinal-epidural anesthesia(CSEA),were randomly allocated to two groups.In the Li DCO group(group L,n=32),we used Li DCO to portray the patients’ beat-to-beat cardiac output(CO)and determine the timing of vasopressor administration,while in the blank group(group B,n=28),we conducted anesthesia under the guidance of the traditional monitors,posture adjustment,and anesthetists’ experience.Fluid administration and sensory planes were standardized for both groups.Our primary outcome was umbilical arterial blood gas PH.Other outcomes included discomfort score,total vasopressor dosage,neonatal umbilical arterial blood gas values,the time span of neonatal birth,and Apgar score.Results: The umbilical arterial blood gas PH of Group L is significantly higher than Group B(P=0.036<0.05).The umbilical arterial blood gas Lac had no statistical difference between the two groups(P=0.098>0.05).The discomfort score was lower in group L than in group B(P=0.006<0.05).The total vasopressor dosage was not significantly different between the two groups(P=0.639>0.05).Although the time span was higher in group B,the difference was not statistically significant(P=0.051>0.05).Conclusion: Hemodynamic targeted management using continuous monitoring of Li DCO in patients with SHS undergoing CD under CSEA showed better neonatal acid-base equilibrium without applying posture adjustment or more vasopressors than usual in patients with SHS.