# Effect of Goal‐Directed Fluid Therapy on Hypotension From Spinal Anesthesia in Older Parturients Having Cesarean Section: A Randomized Controlled Trial

## TL;DR

This study tests if goal-directed fluid therapy reduces hypotension in older mothers during cesarean sections, finding it lowers hypotension rates without harming maternal or infant outcomes.

## Contribution

Demonstrates that stroke volume-guided fluid therapy using echocardiography reduces spinal anesthesia-induced hypotension in older parturients.

## Key findings

- GDFT significantly reduced intraoperative hypotension incidence compared to standard fluid therapy.
- GDFT decreased pre-delivery and intraoperative fluid volumes significantly.
- First postoperative flatus time was shorter in the GDFT group with clinical significance.

## Abstract

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‐directed fluid therapy (GDFT) was used to guide perioperative volume management in order to reduce spinal anesthesia‐induced 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 h, neonatal 1‐min and 5‐min Apgar scores, umbilical artery blood gas analysis, and NICU transfer rate.

A total of 69 AMA parturients with BMI ≤ 35 kg/m2 who underwent elective cesarean section with spinal anesthesia were randomly divided into the control group (Group C, n = 35) and the GDFT group (Group G, n = 34). Group C parturients received compound sodium lactate infusion of 20 mL·kg−1·h−1 before delivery, which was reduced to 5 mL·kg−1·h−1 after delivery. Group G parturients were first given compound sodium lactate 3 mL/kg within 3 min after entering the operating room. Thereafter, under the guidance of transthoracic echocardiography (TTE), when the Δ stroke volume (ΔSV) was ≤ 10%, compound sodium lactate was infused at 5 mL·kg−1·h−1; when the ΔSV was > 10%, the liquid was continued given at 3 mL·kg−1·3 min−1 until ΔSV ≤ 10%, followed by infusion rate of 5 mL·kg−1·h−1. 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) ≤ 80% of baseline value or mean arterial pressure (MAP) ≤ 65 mmHg. Secondary endpoints included intraoperative infusion volume, time to first postoperative flatus, postoperative blood loss within 24 h, neonatal 1‐min and 5‐min Apgar scores, umbilical artery blood gas analysis, and NICU transfer rate.

Compared with Group C, the amount of predelivery fluid and intraoperative infusion in Group G was significantly reduced (p < 0.001), and the incidence of intraoperative hypotension in Group G was significantly decreased (p < 0.05). Compared with T0, SBP was significantly decreased at T1–T3 in both groups (p < 0.05), SV was significantly decreased at T1 in both groups. Compared with Group C, CO was significantly decreased at T1 in Group G (p < 0.05). The first postoperative flatus time was 36.71 ± 10.65 h vs. 31.62 ± 9.19 h, the first ambulation time was 18.06 ± 2.17 h vs. 15.84 ± 2.37 h, and length of stay was 6.37 ± 1.33 days vs. 5.21 ± 1.23 days 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‐min and 5‐min Apgar scores, umbilical artery blood gas (other acid–base balance indexes), and NICU transfer rate between the two groups after delivery.

SV‐oriented 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.

Chinese Registry of Clinical Trials: ChiCTR2300068420