{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T21:14:09Z","timestamp":1789679649193,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":300,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anesthesiology Research and Practice"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The proportion of advanced maternal age (AMA) parturients in China has gradually increased. AMA is considered a risk factor for adverse maternal and fetal outcomes. Goal\u2010directed fluid therapy (GDFT) was used to guide perioperative volume management in order to reduce spinal anesthesia\u2010induced hypotension and optimize maternal and infant outcomes for AMA parturients undergoing cesarean section. The primary endpoint of this study was the incidence of hypotension induced by spinal anesthesia in AMA parturients undergoing cesarean section. Secondary outcomes included intraoperative infusion volume, time to first postoperative flatus, postoperative blood loss within 24\u2009h, neonatal 1\u2010min and 5\u2010min Apgar scores, umbilical artery blood gas analysis, and NICU transfer rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 69 AMA parturients with BMI \u2264 35\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      who underwent elective cesarean section with spinal anesthesia were randomly divided into the control group (Group C,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935) and the GDFT group (Group G,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200934). Group C parturients received compound sodium lactate infusion of 20\u2009mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      before delivery, which was reduced to 5\u2009mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      after delivery. Group G parturients were first given compound sodium lactate 3\u2009mL\/kg within 3\u2009min after entering the operating room. Thereafter, under the guidance of transthoracic echocardiography (TTE), when the \u0394 stroke volume (\u0394SV) was \u2264 10%, compound sodium lactate was infused at 5\u2009mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      ; when the \u0394SV was &gt; 10%, the liquid was continued given at 3\u2009mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b73\u2009min\n                      <jats:sup>\u22121<\/jats:sup>\n                      until \u0394SV\u2009\u2264\u200910%, followed by infusion rate of 5\u2009mL\u00b7kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      \u00b7h\n                      <jats:sup>\u22121<\/jats:sup>\n                      . The primary endpoint was defined as the incidence of hypotension induced by spinal anesthesia in AMA parturients undergoing cesarean section before anesthesia (T0), after completion of subarachnoid block (T1), at fetal delivery (T2), and at the end of surgery (T3), with hypotension defined as systolic blood pressure (SBP)\u2009\u2264\u200980% of baseline value or mean arterial pressure (MAP)\u2009\u2264\u200965\u2009mmHg. Secondary endpoints included intraoperative infusion volume, time to first postoperative flatus, postoperative blood loss within 24\u2009h, neonatal 1\u2010min and 5\u2010min Apgar scores, umbilical artery blood gas analysis, and NICU transfer rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      Compared with Group C, the amount of predelivery fluid and intraoperative infusion in Group G was significantly reduced (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), and the incidence of intraoperative hypotension in Group G was significantly decreased (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). Compared with T0, SBP was significantly decreased at T1\u2013T3 in both groups (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05), SV was significantly decreased at T1 in both groups. Compared with Group C, CO was significantly decreased at T1 in Group G (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). The first postoperative flatus time was 36.71\u2009\u00b1\u200910.65\u2009h vs. 31.62\u2009\u00b1\u20099.19\u2009h, the first ambulation time was 18.06\u2009\u00b1\u20092.17\u2009h vs. 15.84\u2009\u00b1\u20092.37\u2009h, and length of stay was 6.37\u2009\u00b1\u20091.33\u2009days vs. 5.21\u2009\u00b1\u20091.23\u2009days in Group C and Group G, which were not statistically different, but the first postoperative flatus time of the women in Group G was shortened, which has certain clinical significance. There were no significant differences in neonatal 1\u2010min and 5\u2010min Apgar scores, umbilical artery blood gas (other acid\u2013base balance indexes), and NICU transfer rate between the two groups after delivery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SV\u2010oriented GDFT based on TTE can reduce the incidence of hypotension after subarachnoid block during cesarean section in AMA parturients. Although there is no significant difference in maternal and infant outcome, the first postoperative flatus time was shortened with a certain degree of clinical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Chinese Registry of Clinical Trials: ChiCTR2300068420<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/anrp\/2753707","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:30:00Z","timestamp":1761719400000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of Goal\u2010Directed Fluid Therapy on Hypotension From Spinal Anesthesia in Older Parturients Having Cesarean Section: A Randomized Controlled 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