The effect of goal directed fluid, inotrope and vasopressor therapy in preeclamptic patients undergoing caesarean section delivery under spinal anaest - Trial PACTR201604001597634

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Summary

The haemodynamic response to spinal anaesthesia in patients with preeclampsia is poorly understood and often characterised by significant haemodynamic fluctuations which may compromise utero-placental blood flow and so neonatal outcomes. Blood pressure is routinely used as a surrogate marker of cardiac output. Numerous studies have demonstrated a poor correlation between blood pressure and utero-placental blood flow in preeclamptic patients. Furthermore, several studies indicate that the changes in cardiac output induced by spinal anaesthesia are more closely matched to changes in utero-placental blood flow. It may therefore be advantageous to measure cardiac output directly.The availability of new, non-invasive technologies, such as the ClearSight (Edwards LifeSciences, Irvine, California, United States of America), is likely to make perioperative monitoring of cardiac output more accessible, readily applicable and a viable option for the intraoperative management of all preeclamptic patients presenting for caesarean section delivery. The ClearSight has been validated in a number of clinical settings and is approved by the manufacturer for use in obstetric patients. Currently, however, there is a paucity of literature regarding their role in the management of patients undergoing caesarean section delivery. The primary outcome of the study is to document the effect of goal directed therapy using a non-invasive finger cuff cardiac output monitor on umbilical cord lactate in patients with preeclampsia, undergoing caesarean section delivery under spinal anaesthesia. Secondary outcomes include the change in umbilical cord pH, base excess, cortisol levels and neonatal APGAR scores as well as the change in maternal haemodynamic variables including cardiac output, cardiac index, systemic vascular resistance, systemic vascular resistance index and stroke volume variation.

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