Summary Introduction Intra‐operative hypotension is common during caesarean section and may result in adverse maternal effects, such as nausea and vomiting. While oscillometric blood pressure and continuous non‐invasive arterial pressure monitoring enable reactive treatment, the hypotension prediction index offers a machine learning‐based approach that may allow proactive haemodynamic intervention. This study investigated whether hypotension prediction index‐guided management could reduce the incidence of intra‐operative hypotension compared with oscillometric and continuous non‐invasive arterial pressure monitoring. Methods Patients scheduled for elective caesarean section under spinal anaesthesia were allocated randomly to one of three haemodynamic monitoring strategies: oscillometric blood pressure; continuous non‐invasive arterial pressure; or hypotension prediction index‐guided monitoring. Hypotension and hypertension were defined as mean arterial pressure < 65 mmHg and ≥ 100 mmHg, respectively. Hypotension was treated using intermittent intravenous boluses of noradrenaline. The primary outcome was the time‐weighted average of hypotension. Secondary outcomes included time‐weighted average hypertension and maternal adverse effects, including bradycardia, nausea and vomiting. Results Data from 171 patients were analysed. Median time‐weighted average hypotension was significantly higher in patients allocated to the oscillometric and continuous non‐invasive arterial pressure groups compared with the hypotension prediction index group (0.89 mmHg and 0.30 mmHg vs. 0.08 mmHg, respectively, p < 0.001). Patients allocated to the oscillometric group had a higher incidence of maternal nausea and vomiting compared with those allocated to the continuous non‐invasive arterial pressure and hypotension prediction index groups (nausea: 43/59 vs. 29/55 and 30/57, respectively, p = 0.038; and vomiting: 13/59 vs. 6/55 and 3/57, respectively, p = 0.023). Discussion Hypotension prediction index‐guided management during caesarean section significantly reduced intra‐operative hypotension without increasing the risk of hypertension. This approach provides a proactive strategy for haemodynamic optimisation in obstetric anaesthesia.
Shih et al. (Sun,) studied this question.