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Purpose: This study aimed to investigate the efficacy of the ClearSight™ system (Edwards Lifesciences, Irvine, CA) for reducing the incidence of hypotension compared with the traditional oscillometric blood pressure monitoring in cesarean delivery under spinal anesthesia., Methods: Forty patients undergoing cesarean delivery under spinal anesthesia were enrolled. The patients were randomly divided into two groups (Control and ClearSight groups). All patients received spinal anesthesia using 0.5% hyperbaric bupivacaine (11.5 mg) and fentanyl (10 µg). Blood pressure was managed with the same protocol using the ClearSight™ system (ClearSight group) and oscillometric blood pressure monitoring (Control group). Furthermore, we compared the accuracy of the ClearSight™ system with the traditional oscillometric monitoring for blood pressure measurement using Bland-Altman, four-quadrant plot, and polar plot analyses., Results: The incidence of hypotension was significantly lower in the ClearSight group from induction to delivery (45% vs. 0%, p < 0.001) and to the end of surgery (50% vs. 20%, p = 0.049). Intraoperative nausea occurred more frequently in the Control group (45% vs. 10%, p = 0.012). The ClearSight™ system demonstrated acceptable accuracy with a bias of - 4.3 ± 11.7 mmHg throughout the procedure. Four-quadrant analysis revealed an excellent trending ability of the ClearSight™ system with a concordance rate of approximately 95%. In the polar plot analysis, the angular bias and concordance rate were - 13.5° ± 19.0° and 76.9%, respectively., Conclusions: The accuracy and trending ability of the ClearSight™ system for blood pressure measurement was clinically acceptable in cesarean delivery under spinal anesthesia, leading to reductions in maternal hypotension and nausea.

Purpose: General anesthesia for cesarean delivery is frequently associated with hypertension and tachycardia caused by tracheal intubation, which may lead to cardiac ischemia in susceptible patients or may cause harm due to increased intracranial pressure. To prevent these adverse events, we investigated the efficacy and safety of single-dose intravenous administration of landiolol, a short-acting selective β(1) receptor blocker, just prior to intubation., Methods: Patients scheduled for cesarean delivery under general anesthesia were randomized into two groups: landiolol (group L, n = 32); and nontreated (group N, n = 32) patients. After patients entered the operating room, blood pressure (BP), heart rate (HR), and fetal heart beats were monitored to ensure no problems were present, then thiopental 5 mg/kg and rocuronium 0.9 mg/kg were given. In addition, group L received a single dose of landiolol 0.2 mg/kg. After tracheal intubation, anesthesia was maintained in both groups using sevoflurane. From before starting anesthesia to the time of delivery, BP, HR, need for additional treatment with uterotonic or vasopressor agents, and neonatal Apgar scores were recorded. Data were compared between groups., Results: Group L showed significantly lower percentage changes in BP and HR than group N (p < 0.05 each). Intraoperative blood loss, frequency of decreased uterine contraction, and fetal Apgar scores did not differ significantly between groups., Conclusions: In our study, landiolol reduced BP and HR changes during anesthesia induction, whereas no adverse effects on uterine contraction or the fetus were seen. These findings suggest landiolol provides adequate hemodynamic regulation during general anesthesia induction in patients undergoing cesarean delivery.

Purpose: Spinal anesthesia is a standard technique for cesarean delivery; however, it possesses a risk of hypotension. We hypothesised that the changes in the corrected flow time induced by the Trendelenburg position could predict the incidence of hypotension after spinal anesthesia for cesarean delivery. Methods: Patients undergoing elective cesarean delivery under spinal anesthesia were enrolled. Before anesthesia induction, corrected flow time was measured in the supine and Trendelenburg positions (FTc-1 and FTc-2, respectively). Additionally, a percent change in corrected flow time induced by the Trendelenburg position was defined as ΔFTc. The primary endpoint was to investigate the ability of ΔFTc to predict the incidence of spinal anesthesia-induced hypotension until delivery. The receiver operating characteristics curves to assess the ability of FTc-1, FTc-2, and ΔFTc to predict the incidence of hypotension were generated. Results: Finally, 40 patients were included, and of those, 26 (65%) developed spinal anesthesia-induced hypotension. The areas under the curve for FTc-1, FTc-2, and ΔFTc were 0.591 (95% CI: 0.424 to 0.743) (P = 0.380), 0.742 (95% CI: 0.579 to 0.867) (P = 0.004), and 0.882 (95% CI: 0.740 to 0.962) (P < 0.001) respectively, indicating ΔFTc as the best predictor among these three parameters. The best threshold for ΔFTc was 6.4% (sensitivity: 80.8% (95% CI: 53.8 to 96.2), specificity: 85.7% (95% CI: 42.9 to 100.0)). Conclusions: This study demonstrated that changes in the corrected carotid flow time induced by the Trendelenburg position could serve as a good predictor of spinal anesthesia-induced hypotension for cesarean delivery. [ABSTRACT FROM AUTHOR]

This document is a reply to a comment made on a manuscript regarding the prediction of spinal anesthesia-induced hypotension for cesarean delivery. The authors acknowledge the concerns raised about the level of sensory block and its impact on hemodynamic stability. However, they disagree with the notion that a sensory blockade level of ≤ T4 is excessive for performing spinal anesthesia for cesarean section, citing literature that supports T4-T6 as the appropriate level. They also argue that their study's definition of hypotension and the incidence of hemodynamic instability in their patients were not significantly different from previous studies. The authors maintain that their results are reliable and applicable to patients undergoing cesarean delivery with spinal anesthesia. [Extracted from the article]