Comparisons of Blood Pressure Control Ability Between HPI, ClearSight, and Conventional NIBP During Neuraxial Anesthesia in Cesarean Section

Not Applicable

Recruiting

Interventions: Device: non-invasive arterial pressure waveforms
Device: hypotension prediction index derived from non-invasive arterial pressure waveforms

Brief Summary: The goal of this study is to compare the blood pressure control ability with HPI, ClearSight, and conventional NIBP during neuraxial anesthesia in cesarean section. The main question it aims to answer is:

Anesthesiologists can have a better control of blood pressure during cesarean section with HPI than with conventional NIBP.

During the surgery, the participants will be monitored with standard monitor and HPI with ClearSight and will be randomly assigned to three groups, including HPI group, ClearSight group, and NIBP group. Anesthesiologists will treat intraoperative hypotension with different protocols according to the participants' allocation. Investigators will compare the time-weighted average mean arterial pressure \< 65mmHg with in three groups. Secondary outcomes includes the intraoperative hypotension rate, total duration of hypotension, the hypotension symptoms and signs of parturients.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

parturients with preeclampsia
parturients with cardiovascular disease above NYHA functional class 2
parturients with arrhythmias, preoperative severe hypertension, or other severe cardiopulmonary diseases.
severe perioperative arrhythmias with or without hemodynamic instability
failed neuraxial anesthesia or regional blockade level below T6

Arm && Interventions

Group	Intervention	Description
ClearSight	non-invasive arterial pressure waveforms	Standard intraoperative monitor and non-invasive continuous arterial pressure waveforms (ClearSight) are set up in this group. ClearSight data and HPI derived from ClearSight are used for recording, and HPI are masked for attending anesthesiologists. Blood pressure is monitored with ClearSight. Attending anesthesiologists controlled the blood pressure according to continuous arterial pressure values. 1. Maintain mean arterial pressure (MAP) above 65 mmHg 2. MAP \< 65mmHg and heart rate \> 60/min, IV bolus norepinephrine 5-10 mcg 3. MAP \< 65mmHg and heart rate \< 60/min, IV bolus norepinephrine 5-10 mcg with atropine 0.01 mg/kg
HPI	hypotension prediction index derived from non-invasive arterial pressure waveforms	Standard intraoperative monitor and non-invasive continuous arterial pressure waveforms (ClearSight) are set up in this group. ClearSight data and hypotension prediction index (HPI) derived from ClearSight are used for recording and monitoring. Blood pressure is monitored with ClearSight and HPI. Attending anesthesiologists controlled the blood pressure according to HPI values. 1. Maintain HPI below 85 2. HPI \> 85 and heart rate \> 60/min, IV bolus norepinephrine 5-10 mcg 3. HPI \> 85 and heart rate \< 60/min, IV bolus norepinephrine 5-10 mcg with atropine 0.01 mg/kg

Primary Outcome Measures

Name	Time	Method
time-weighted MAP below 65 mmHg	through the surgery completion, an average of 1.5 hours

Secondary Outcome Measures

Name	Time	Method
rate of hypotension related symptoms and sign of the parturients	through the surgery completion, an average of 1.5 hours	symptoms and signs include nausea, vomiting, bradycardia, dizziness, and shivering
total vasopressor dosage	through the surgery completion, an average of 1.5 hours	average norepinephrine dosage used during the surgery
rates of parturients with intraoperative hypotension	through the surgery completion, an average of 1.5 hours	hypotension is defined as MAP below 65 mmHg for more than 1 minute
total hypotension duration	through the surgery completion, an average of 1.5 hours	hypotension is defined as MAP below 65 mmHg for more than 1 minute
area under curve of hypotension	through the surgery completion, an average of 1.5 hours	hypotension is defined as MAP below 65 mmHg for more than 1 minute
average regional cerebral oxygen saturation	through the surgery completion, an average of 1.5 hours