04AP11-10 Feasibility study: non-invasive hemodynamic monitoring during cesarean section and intraoperative fluidic management

Background and Goal of Study: Maternal and neonatal outcome secondary to caesarean section surgery improved thanks to the evolution of surgical/anaesthetic techniques. Anaesthetic management aims to eliminate the algic stimulus and to reduce hemodynamic alterations linked to blood loss, caval compression and the vasodilatation(loco-regional anesthesia, ALR).The approaches to ALR-induced hypotension are defined as PRELOAD(fluid load carried out before anesthesia) and COLOAD(fluid load given during the execution of anesthesia), with no general standardization.This observational study aimed to evaluate the use of non-invasive hemodynamic monitoring in comparing the 2 approaches in patients undergoing a caesarean section under subarachnoid anesthesia. Materials and Methods: Pregnant patients (18-40 years), single fetus, gestational age> 36 w, ASA I, ordinary hospitalization were included. Two groups were identified depending on the choice of the present anesthesiologist. PRELOAD: pre-intervention 1 L of balanced solution, followed by 500 mL during the surgery; COLOAD:500 mL of balanced solution started during ALR execution. Monitoring: usual + Clear-sight probe (EV1000-Edwards Lifescience). Precise waypoints were identified: baseline, fluid-load, ALR, incision, fetal extraction, afterbirth. Results and Discussion: 18 patients. The two groups showed no significant differences in height, weight, ASA, comorbidity, home therapy, gestational week and CS indication. The characteristics of ALR was found to be superimposable in the 2 groups.Blood losses were not significantly different, as were the outcome of newborns (APGAR at I and V minute, umbilical blood gas values, weight in I and III day).The haemodynamic variables showed considerable inter-individual variability over time, but were not significantly different between the 2 groups, in relation to the received fluid load. Conclusion: The use of a completely non-invasive hemodynamic monitoring was proven feasible, reliable and well tolerated. Different fluid regimens do not significantly modify pregnant woman’s haemodynamics, nor the newborn’s conditions. The volume given before ALR may result ineffective (redistribution).