Journal of Anesthesia

, Volume 32, Issue 6, pp 822–830 | Cite as

Impact of non-invasive continuous blood pressure monitoring on maternal hypotension during cesarean delivery: a randomized-controlled study

  • Takashi Juri
  • Koichi SuehiroEmail author
  • Aya Kimura
  • Akira Mukai
  • Katsuaki Tanaka
  • Tokuhiro Yamada
  • Takashi Mori
  • Kiyonobu Nishikawa
Original Article



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.


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.


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.


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.


ClearSight™ Cesarean delivery Hypotension Spinal anesthesia 



Only departmental funds were used for this study.

Compliance with ethical standards

Conflict of interest

K. S. has received a speaker fee from Edwards LifeSciences in the 5th annual meeting of Japanese Society of Regional Anesthesia (held on 4/13/2018, Osaka, Japan).


  1. 1.
    Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54:909–21.CrossRefPubMedGoogle Scholar
  2. 2.
    Ngan Kee WD, Khaw KS. Vasopressors in obstetrics: what should we be using? Curr Opin Anaesthesiol. 2006;19:238–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Sng BL, Wang H, Assam PN, Sia AT. Assessment of an updated double-vasopressor automated system using Nexfin for the maintenance of haemodynamic stability to improve peri-operative outcome during spinal anaesthesia for caesarean section. Anaesthesia. 2015;70:691–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology. 2002;97:1274–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Hawkins JL, Chang J, Palmer SK, Gibbs CP, Callaghan WM. Anesthesia-related maternal mortality in the United States: 1979–2002. Obstet Gynecol. 2011;117:69–74.CrossRefPubMedGoogle Scholar
  6. 6.
    Butwick AJ, Columb MO, Carvalho B. Preventing spinal hypotension during caesarean delivery: what is the latest? Br J Anaesth. 2015;114:183–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, Palanisamy A, Sia ATH, Van de Velde M, Vercueil A. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73:71–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Bartels K, Esper SA, Thiele RH. Blood pressure monitoring for the anesthesiologist: a practical review. Anesth Analg. 2016;122:1866–79.CrossRefPubMedGoogle Scholar
  9. 9.
    Tsuchiya M, Takahashi R, Furukawa A, Suehiro K, Mizutani K, Nishikawa K. Transversus abdominis plane block in combination with general anesthesia provides better intraoperative hemodynamic control and quicker recovery than general anesthesia alone in high-risk abdominal surgery patients. Minerva Anestesiol. 2012;78:1241–7.PubMedGoogle Scholar
  10. 10.
    Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefPubMedGoogle Scholar
  11. 11.
    Myles PS, Cui J. Using the Bland–Altman method to measure agreement with repeated measures. Br J Anaesth. 2007;99:309–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Kim SH, Lilot M, Sidhu KS, Rinehart J, Yu Z, Canales C, Cannesson M. Accuracy and precision of continuous noninvasive arterial pressure monitoring compared with invasive arterial pressure: a systematic review and meta-analysis. Anesthesiology. 2014;120:1080–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Critchley LA, Yang XX, Lee A. Assessment of trending ability of cardiac output monitors by polar plot methodology. J Cardiothorac Vasc Anesth. 2011;25:536–46.CrossRefPubMedGoogle Scholar
  14. 14.
    Suehiro K, Tanaka K, Yamada T, Matsuura T, Funao T, Mori T, Nishikawa K. The utility of intra-operative three-dimensional transoesophageal echocardiography for dynamic measurement of stroke volume. Anaesthesia. 2015;70:150–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Suehiro K, Tanaka K, Yamada T, Matsuura T, Mori T, Funao T, Nishikawa K. The ability of the Vigileo-FloTrac system to measure cardiac output and track cardiac output changes during one-lung ventilation. J Clin Monit Comput. 2015;29:333–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Okudaira S, Suzuki S. Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies. Arch Gynecol Obstet. 2005;271:292–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Mercier FJ, Diemunsch P, Ducloy-Bouthors AS, Mignon A, Fischler M, Malinovsky JM, Bolandard F, Aya AG, Raucoules-Aime M, Chassard D, Keita H, Rigouzzo A, Le Gouez A, Group CW. 6% hydroxyethyl starch (130/0.4) vs Ringer’s lactate preloading before spinal anaesthesia for caesarean delivery: the randomized, double-blind, multicentre CAESAR trial. Br J Anaesth. 2014;113:459–67.CrossRefPubMedGoogle Scholar
  18. 18.
    Matsota P, Karakosta A, Pandazi A, Niokou D, Christodoulaki K, Kostopanagiotou G. The effect of 0.5 L 6% hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis. J Anesth. 2015;29:352–9.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ngan Kee WD, Khaw KS, Lee BB, Lau TK, Gin T. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2000;90:1390–5.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    van Bogaert LJ. Prevention of post-spinal hypotension at elective cesarean section by wrapping of the lower limbs. Int J Gynaecol Obstet. 1998;61:233–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Miyabe M, Sato S. The effect of head-down tilt position on arterial blood pressure after spinal anesthesia for cesarean delivery. Reg Anesth. 1997;22:239–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Qian XW, Chen XZ, Li DB. Low-dose ropivacaine-sufentanil spinal anaesthesia for caesarean delivery: a randomised trial. Int J Obstet Anesth. 2008;17:309–14.CrossRefPubMedGoogle Scholar
  23. 23.
    Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH. Autonomic reflex dysfunction in patients presenting for elective surgery is associated with hypotension after anesthesia induction. Anesthesiology. 1994;80:326–37.CrossRefPubMedGoogle Scholar
  24. 24.
    Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control. 2014;7:49–59.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lin FQ, Li C, Zhang LJ, Fu SK, Chen GQ, Yang XH, Zhu CY, Li Q. Effect of rapid plasma volume expansion during anesthesia induction on haemodynamics and oxygen balance in patients undergoing gastrointestinal surgery. Int J Med Sci. 2013;10:355–61.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hirose N, Kondo Y, Maeda T, Suzuki T, Yoshino A. Relationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section. J Anesth. 2016;30:603–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Meidert AS, Nold JS, Hornung R, Paulus AC, Zwißler B, Czerner S. The impact of continuous non-invasive arterial blood pressure monitoring on blood pressure stability during general anaesthesia in orthopaedic patients: a randomised trial. Eur J Anaesthesiol. 2017;34:716–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Ilies C, Kiskalt H, Siedenhans D, Meybohm P, Steinfath M, Bein B, Hanss R. Detection of hypotension during Caesarean section with continuous non-invasive arterial pressure device or intermittent oscillometric arterial pressure measurement. Br J Anaesth. 2012;109:413–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Akkermans J, Diepeveen M, Ganzevoort W, van Montfrans GA, Westerhof BE, Wolf H. Continuous non-invasive blood pressure monitoring, a validation study of Nexfin in a pregnant population. Hypertens Pregnancy. 2009;28:230–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Chen G, Chung E, Meng L, Alexander B, Vu T, Rinehart J, Cannesson M. Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management. J Clin Monit Comput. 2012;26:133–40.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyOsaka City University Graduate School of MedicineOsakaJapan

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