scholarly journals Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Shan-Han Yang ◽  
Yi-Shiuan Lin ◽  
Chien-Nan Lee ◽  
Ya-Jung Cheng ◽  
Ying-Hsi Chen ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Fluid Therapy ◽  
Fluid Challenge ◽  
Fixed Dose ◽  
Control Group ◽  
Crystalloid Fluid ◽  
Goal Directed Fluid Therapy

Background. Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation. Method. In total, 71 consecutive full-term pregnant women were randomly divided into a control group ( n = 34 ) and a GDFT group ( n = 37 ). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles. Result. Women in the GDFT group received more fluid than did those in the control group ( 1132 ± 108 vs. 1247 ± 202  mL; p = 0.0044 ), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864 ) and norepinephrine dose ( 12.5 ± 10.6 vs. 15.1 ± 12.8  mcg, respectively; p = 0.3512 ) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332 ). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups. Conclusion. ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

scholarly journals Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia

2008 ◽  
Vol 108 (5) ◽  
pp. 802-811 ◽  
Author(s):  
Robert A. Dyer ◽  
Jenna L. Piercy ◽  
Anthony R. Reed ◽  
Carl J. Lombard ◽  
Leann K. Schoeman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Severe Preeclampsia

Background Hemodynamic responses to spinal anesthesia (SA) for cesarean delivery in patients with severe preeclampsia are poorly understood. This study used a beat-by-beat monitor of cardiac output (CO) to characterize the response to SA. The hypothesis was that CO would decrease from baseline values by less than 20%. Methods Fifteen patients with severe preeclampsia consented to an observational study. The monitor employed used pulse wave form analysis to estimate nominal stroke volume. Calibration was by lithium dilution. CO and systemic vascular resistance were derived from the measured stroke volume, heart rate, and mean arterial pressure. In addition, the hemodynamic effects of phenylephrine, the response to delivery and oxytocin, and hemodynamics during recovery from SA were recorded. Hemodynamic values were averaged for defined time intervals before, during, and after SA. Results Cardiac output remained stable from induction of SA until the time of request for analgesia. Mean arterial pressure and systemic vascular resistance decreased significantly from the time of adoption of the supine position until the end of surgery. After oxytocin administration, systemic vascular resistance decreased and heart rate and CO increased. Phenylephrine, 50 mug, increased mean arterial pressure to above target values and did not significantly change CO. At the time of recovery from SA, there were no clinically relevant changes from baseline hemodynamic values. Conclusions Spinal anesthesia in severe preeclampsia was associated with clinically insignificant changes in CO. Phenylephrine restored mean arterial pressure but did not increase maternal CO. Oxytocin caused transient marked hypotension, tachycardia, and increases in CO.

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

Goal-Directed Fluid Therapy Based on Stroke Volume Variation in Patients Undergoing Major Spine Surgery in the Prone Position

Spine ◽  
2016 ◽  
Vol 41 (18) ◽  
pp. E1131-E1137 ◽  
Author(s):  
Maria Renata Bacchin ◽  
Chiara Marta Ceria ◽  
Sandra Giannone ◽  
Daniela Ghisi ◽  
Gaetano Stagni ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prone Position ◽  
Spine Surgery ◽  
Fluid Therapy ◽  
Stroke Volume Variation ◽  
Volume Variation ◽  
Goal Directed Fluid Therapy

scholarly journals Efficacy of Goal-Directed Fluid Therapy Monitored by Pulse-Pressure Variation Using a C ontinuous Non-Invasive Arterial Pressure Monitoring System (the CNAPTM System) During Parathyroidectomy in Patients with End-Stage Renal Failure - A randomized trial

2019 ◽  
Author(s):  
Jie Song ◽  
Xiaofen Liu ◽  
Weiwei Jiang ◽  
Jiayou Wang ◽  
Yun Li ◽  
...  
Keyword(s):  
Renal Failure ◽  
Arterial Pressure ◽  
Fluid Therapy ◽  
Normal Saline ◽  
Fluid Management ◽  
Pressure Variation ◽  
End Stage Renal Failure ◽  
Intraoperative Period ◽  
Goal Directed Fluid Therapy ◽  
End Stage

Abstract Background: There are no well-recognized guidelines for intraoperative fluid management in patients with end-stage renal failure (ESRF) . Goal-directed fluid therapy (GDFT) is a concept of perioperative fluid management that improves patients’ prognosis. Dynamic indicators better predict fluid response than static indicators. Aim: In this study, we assessed a GDFT protocol with monitoring of pulse pressure variation (PPV) in patients with ESRF undergoing parathyroidectomy. Methods: The study included 102 patients who underwent elective parathyroidectomy. They were randomized to a control group (restrictive group, n = 51) that was managed with a restricted fluid regimen or a PPV group (GDFT group, n = 51) that was given a normal saline infusion and was monitored for change in PPV during the intraoperative period. If PPV reached >13%, 250 mL normal saline was administered over 15 min. Ephedrine was given at increments of 6 mg to keep mean arterial pressure >65 mmHg . Hemodynamic variables in the perioperative period were recorded. The primary endpoint was the occurrence of postoperative hypotension. Results: The occurrence of postoperative hypotension in the GDFT group was lower than in the restrictive group (0 vs. 11.67%, P = 0.027). The patients with complications in the GDFT group was lower than in the restrictive group (35.3% vs. 54.9%, P = 0.047). The volume of saline infused during the intraoperative period was 364 (219-408) mL in the GDFT group and 50 (50-50) mL in the restrictive group ( P = 0.001). Ephedrine was given to 16/51 (29.4%) of the GDFT group and 27/51 (52.9%) of the restrictive group ( P = 0.027). Conclusion: The use of goal-directed fluid therapy with the dynamic PPV indicator in patients with ESRF undergoing parathyroidectomy guides the administration of infused fluids, with reduced incidence of postoperative hypotension.

scholarly journals The Impact of Goal-Directed Fluid Therapy in Prolonged Major Abdominal Surgery on Extravascular Lung Water and Oxygenation: A Randomized Controlled Trial

2019 ◽  
Vol 7 (8) ◽  
pp. 1276-1281
Author(s):  
Ahmed Hasanin ◽  
Karim Hussein Mourad ◽  
Inas Farouk ◽  
Sherin Refaat ◽  
Ahmed Nabih ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Extravascular Lung Water ◽  
Stroke Volume Variation ◽  
Major Abdominal Surgery ◽  
Control Group ◽  
Lung Water ◽  
Goal Directed Fluid Therapy ◽  
Ultrasound Score ◽  
The Impact

BACKGROUND: A growing interest had been paid to goal-directed fluid therapy (GDT) in abdominal surgery; however, its impact on the respiratory profile was not well investigated. AIM: We evaluated the impact of GDT on postoperative extravascular lung water and oxygenation after prolonged major abdominal surgery. METHODS: A randomised, controlled study was conducted in Kasr Alainy hospital from April 2016 till December 2017 including 120 adult patients scheduled for prolonged major abdominal surgery. Patients were randomised into either GDT group (n = 60) who received baseline restricted fluid therapy (2 mL/Kg/hour) which is guided by stroke volume variation, or control group (n = 60) who received standard care. Both study groups were compared according to hemodynamic data, fluid requirements, lung ultrasound score, and PaO2/fraction of inspired oxygen ratio (P/F ratio), RESULTS: Intraoperatively, GDT group received less volume of fluids and showed higher intraoperative mean arterial pressure compared to the control group. Postoperatively, lung ultrasound score was lower, and P/F ratio was higher in the GDT group compared to the control group. The number of patients who showed a significant postoperative increase in LUS was higher in the control group 44 (73%) patients versus 14 (23%) patients, P < 0.001). CONCLUSIONS: Using stroke volume variation for guiding fluid therapy in prolonged, major abdominal operations were associated with better hemodynamic profile, less intraoperative fluid administration, lower extravascular lung water and better oxygenation compared to standard care.

scholarly journals Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E871-E876
Author(s):  
Khalid M. Morsy
Keyword(s):  
Chronic Pain ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Dural Puncture ◽  
Control Group ◽  
Elective Cesarean Delivery ◽  
Post Dural Puncture Headache ◽  
Elective Cesarean ◽  
Control Study

Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition. Objective: The current study aims to verify the incidence and chronicity of PDPH in FMS patients. Study Design: Case control study. Methods: In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women scheduled for elective cesarean delivery who had no history of chronic pain and is used as a control group. Both groups were compared regarding the incidence of development of PDPH in the first postoperative 48 hours and the persistence of PDPH for 7 days or more. Settings: Women’s Health Hospital, Assiut University, antenatal Clinic. Results: The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to the control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH continued for more than 3 months in 2 patients in the fibromyalgia group (2.86%) Limitations: Difficulty in calculating the dose of analgesics as patients with fibromyalgia may use other analgesics due to musculoskeletal pain. Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients in comparison with normal controls without increasing other postoperative side effects. Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia

scholarly journals Stroke volume variation is a good predictor of fluid responsiveness in cardiac surgery patients with implanted intra-arortic balloon pump

2021 ◽  
Author(s):  
Rostislav Enev ◽  
Filip Abedinov ◽  
Neda Bakalova
Keyword(s):  
Cardiac Surgery ◽  
Stroke Volume ◽  
Fluid Responsiveness ◽  
Fluid Therapy ◽  
Good Predictor ◽  
Stroke Volume Variation ◽  
Fluid Challenge ◽  
Pulse Contour ◽  
Important Variable ◽  
Volume Variation

Abstract There is a vast body of evidence in favor of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Materials and methods: Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standy mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. Results: SVV above 8.5% showed a good correlation with fuid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) Conclusion: SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.

scholarly journals The Influence of Body Mass Index on Sensorimotor Block and Vasopressor Requirement during Spinal Anesthesia for Elective Cesarean Delivery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N M A Elsayed ◽  
S S W Rizkallah ◽  
R M H Maamoon ◽  
S H A Ahmed
Keyword(s):  
Body Mass Index ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Fixed Dose ◽  
Morbidly Obese ◽  
Elective Cesarean Delivery ◽  
Organ Systems ◽  
Block Level ◽  
Elective Cesarean

Abstract Background Physiological changes associated with pregnancy are significant enough to have serious anesthetic implications. When these are compounded by obesity, the anesthesiologists may have to deal with a patient with seriously limited physiological reserve. Obese patients often had co-morbidities and pathological changes in different organ systems. Aim The objective of this study is to determine if obesity have a clinical important effect on the vasopressor requirements or the block height following a standard fixed dose of spinal anesthesia during elective cesarean delivery. Methodology In this prospective randomized comparative clinical study, two groups of 33 patients were recruited with widely differing body mass indices to examine the influence of body mass index (BMI) on the responses to a specific dose of spinal bupivacaine. One group includes women with BMI &lt; 32 kg/m2 (group N) and the other group has a BMI of &gt; 40 kg/m2 (group O). Results This study showed that Body Mass Index doesn’t have much influence on sensorimotor block level and vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients. Conclusion The result of the present study showed that Body Mass Index up to 50 doesn’t have much influence on sensorimotor block level or vasopressor requirement during spinal anesthesia for elective cesarean delivery &so the dose of spinal bupivacaine should not be reduced in morbidly obese parturients.

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