Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Department of Anesthesiology, Shuguang Hospital Affiliated With Shanghai University of Traditional Chinese Medicine, Shanghai, China.
BMC Anesthesiol. 2023 Aug 24;23(1):288. doi: 10.1186/s12871-023-02242-6.
Hypotension frequently occurs after spinal anesthesia during cesarean delivery, and fluid loading is recommended for its prevention. We evaluated the efficacy of subclavian vein (SCV) ultrasound (US)-guided volume optimization in preventing hypotension after spinal anesthesia during cesarean delivery.
This randomized controlled study included 80 consecutive full-term parturients scheduled for cesarean delivery under spinal anesthesia. The women were randomly divided into the SCVUS group, with SCVUS analysis before spinal anesthesia with SCVUS-guided volume management, and the control group without SCVUS assessment. The SCVUS group received 3 mL/kg crystalloid fluid challenges repeatedly within 3 min with a 1-min interval based on the SCV collapsibility index (SCVCI), while the control group received a fixed dose (10 mL/kg). Incidence of post-spinal anesthetic hypotension was the primary outcome. Total fluid volume, vasopressor dosage, changes in hemodynamic parameters, maternal adverse effects, and neonatal status were secondary outcomes.
The total fluid volume was significantly higher in the control group than in the SCVUS group (690 [650-757.5] vs. 160 [80-360] mL, p < 0.001), while the phenylephrine dose (0 [0-40] vs. 0 [0-30] µg, p = 0.276) and incidence of post-spinal anesthetic hypotension (65% vs. 60%, p = 0.950) were comparable between both the groups. The incidence of maternal adverse effects, including nausea/vomiting and bradycardia (12.5% vs. 17.5%, p = 0.531 and 7.5% vs. 5%, p = 1.00, respectively), and neonatal outcomes (Apgar scores) were comparable between the groups. SCVCI correlated with the amount of fluid administered (R = 0.885, p < 0.001).
SCVUS-guided volume management did not ameliorate post-spinal anesthetic hypotension but reduced the volume of the preload required before spinal anesthesia. Reducing preload volume did not increase the incidence of maternal and neonatal adverse effects nor did it increase the total vasopressor dose. Moreover, reducing preload volume could relieve the heart burden of parturients, which has high clinical significance.
The trial was registered with the Chinese Clinical Trial Registry at chictr.org.cn (registration number, ChiCTR2100055050) on December 31, 2021.
剖宫产术中脊髓麻醉后常发生低血压，推荐进行液体负荷以预防低血压。我们评估了锁骨下静脉（SCV）超声（US）引导下容量优化在预防剖宫产术中脊髓麻醉后低血压的效果。
这是一项随机对照研究，纳入了 80 例计划行脊髓麻醉下剖宫产的足月产妇。这些妇女被随机分为 SCVUS 组，在脊髓麻醉前进行 SCVUS 分析，并进行 SCVUS 指导下的容量管理；对照组不进行 SCVUS 评估。SCVUS 组根据 SCV 塌陷指数（SCVCI）在 3 分钟内重复给予 3 mL/kg 晶体液冲击，间隔 1 分钟；对照组给予固定剂量（10 mL/kg）。主要结局为脊髓麻醉后低血压的发生率。总液体量、血管加压药剂量、血流动力学参数变化、产妇不良反应和新生儿情况为次要结局。
对照组的总液体量明显高于 SCVUS 组（690 [650-757.5] vs. 160 [80-360] mL，p<0.001），而苯肾上腺素剂量（0 [0-40] vs. 0 [0-30] µg，p=0.276）和脊髓麻醉后低血压的发生率（65% vs. 60%，p=0.950）在两组间无差异。两组产妇不良反应（恶心/呕吐和心动过缓）发生率（12.5% vs. 17.5%，p=0.531 和 7.5% vs. 5%，p=1.00）和新生儿结局（Apgar 评分）无差异。SCVCI 与输入的液体量呈正相关（R=0.885，p<0.001）。
SCVUS 指导下的容量管理并未改善脊髓麻醉后低血压，但减少了脊髓麻醉前所需的预充量。减少预充量并未增加产妇和新生儿不良反应的发生率，也未增加总血管加压药剂量。此外，减少预充量可以减轻产妇的心脏负担，具有重要的临床意义。
该试验于 2021 年 12 月 31 日在中国临床试验注册中心（注册号：ChiCTR2100055050）注册。
