{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:40:58Z","timestamp":1787506858831,"version":"build-2736575974"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n BACKGROUND<\/jats:title>\n Hypotension following spinal anaesthesia during caesarean section is common and can negatively affect the mother and child.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n This study aimed to assess whether spinal anaesthesia-induced hypotension could be prevented using noninvasive cardiac output monitoring.<\/jats:p>\n <\/jats:sec>\n \n DESIGN<\/jats:title>\n Randomised controlled study.<\/jats:p>\n <\/jats:sec>\n \n SETTING<\/jats:title>\n This single-centre study was conducted at a Japanese hospital from 13 May 2020 to 27 April 2022.<\/jats:p>\n <\/jats:sec>\n \n PATIENTS<\/jats:title>\n \n Women (\n n<\/jats:italic>\n \u200a=\u200a200) who underwent elective caesarean delivery under spinal anaesthesia were included. The exclusion criteria were age <20\u200ayears, ASA physical status \u22653, and contraindications to combined spinal and epidural anaesthesia.\n <\/jats:p>\n <\/jats:sec>\n \n INTERVENTION<\/jats:title>\n The participants were randomised via simple randomisation into the estimated continuous cardiac output-guided vasopressor administration (esCCO group) or control group. Blood pressure was measured at 2.5-min intervals following intrathecal 10\u200amg hyperbaric bupivacaine injection. Patients in both groups received a single dose of vasopressor (phenylephrine 100\u200a\u03bcg or ephedrine 4\u200amg) if they had hypotension (systolic BP <100\u200ammHg and\/or mean BP <65\u200ammHg) or nausea. In the esCCO group, phenylephrine was also administered if the esCCO decreased by 10% or more from baseline.<\/jats:p>\n <\/jats:sec>\n \n MAIN OUTCOME MEASURES<\/jats:title>\n \n The primary outcome was the proportion of patients with hypotension (systolic blood pressure < 100\u200ammHg and\/or mean blood pressure < 65\u200ammHg) between the spinal anaesthesia injection and delivery. The secondary outcomes were nausea and vomiting, reactive hypertension (systolic BP \u2265 140\u200ammHg), and umbilical arterial blood pH. Fisher's exact test and Student's\n t<\/jats:italic>\n -test were used for analysis.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n The incidence of hypotension was 43\/88 (49%) in the control group and 20\/103 (19%) in the esCCO group (\n P<\/jats:italic>\n < 0.001). The delivered phenylephrine dose was 186 \u00b1 149\u200a\u03bcg in the control group and 262 \u00b1 189\u200a\u03bcg in the esCCO group (\n P<\/jats:italic>\n = 0.003). The incidences of nausea and vomiting, reactive hypertension, and umbilical arterial blood pH did not differ between the groups.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n The incidence of hypotension may be reduced using estimated continuous CO monitoring, however, no differences were seen in the incidence of nausea or reactive hypertension, nor in umbilical arterial pH levels.<\/jats:p>\n <\/jats:sec>\n \n TRIAL REGISTRATION<\/jats:title>\n UMIN-CTR Clinical Trial Database identifier: UMIN000040066.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ea9.0000000000000086","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:00:29Z","timestamp":1755792029000},"page":"e0086","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Prevention of spinal anaesthesia-induced hypotension during caesarean section using noninvasive cardiac output monitoring"],"prefix":"10.1097","volume":"4","author":[{"given":"Midoriko","family":"Higashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Shirozu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Sumie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taichi","family":"Ando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiki","family":"Akasaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Yumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Hojo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9392-1746","authenticated-orcid":false,"given":"Ken","family":"Yamaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10]]},"reference":[{"key":"R1-20250821","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/anae.14080","article-title":"International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia","volume":"73","author":"Kinsella","year":"2018","journal-title":"Anaesthesia"},{"key":"R2-20250821","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/ACO.0b013e32834588c5","article-title":"Maternal haemodynamic changes during spinal anaesthesia for caesarean section","volume":"24","author":"Langes\u00e6ter","year":"2011","journal-title":"Curr Opin Anaesthesiol"},{"key":"R3-20250821","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/anae.12445","article-title":"Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis","volume":"69","author":"Heesen","year":"2014","journal-title":"Anaesthesia"},{"key":"R4-20250821","first-page":"Cd002251","article-title":"Techniques for preventing hypotension during spinal anaesthesia for caesarean section","volume":"7","author":"Chooi","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"R5-20250821","first-page":"233","article-title":"The pupillary light reflex for predicting the risk of hypotension after spinal anaesthesia for elective caesarean section","volume":"37","author":"Riffard","year":"2018","journal-title":"Anaesth Crit Care Pain Med"},{"key":"R6-20250821","first-page":"100904","article-title":"Maternal heart rate responses in the supine position and their relationship with hypotension and phenylephrine requirements during elective caesarean delivery using spinal anaesthesia: An observational study","volume":"40","author":"Brebion","year":"2021","journal-title":"Anaesth Crit Care Pain Med"},{"key":"R7-20250821","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1213\/ANE.0b013e3181e8137b","article-title":"Positional blood pressure change and the risk of hypotension during spinal anesthesia for cesarean delivery: an observational study","volume":"111","author":"Jeon","year":"2010","journal-title":"Anesth Analg"},{"key":"R8-20250821","doi-asserted-by":"crossref","first-page":"312","DOI":"10.4103\/sja.SJA_27_19","article-title":"Role of IVC collapsibility index to predict post spinal hypotension in pregnant women undergoing caesarean section. 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