• Singaraselvan Nagarajan, Jason Ju In Chan, Chin Wen Tan, Zainab Ghalib A Al-Hashim, Rehena Sultana, SiaAlex Tiong HengATH, and Ban Leong Sng.
• From the Department of Women's Anaesthesia, KK Women's and Children's Hospital (SN, JJIC, CWT, ZGAAH, AT, BLS), Duke-NUS Medical School (SN, JJIC, CWT, AT, BLS), and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore (RS).
• Eur J Anaesthesiol. 2022 Jan 1; 39 (1): 424942-49.

BackgroundDuring spinal anaesthesia for caesarean section, haemodynamic instability may lead to maternal and foetal complications. We developed a novel advanced double intravenous vasopressor automated system (ADIVA) by using a continuous blood pressure and heart rate monitor. Treatment of hypotension was based on three criteria: the drug (phenylephrine or ephedrine) according to the heart rate; the dose of vasopressor determined by the degree of hypotension; a fast or slow bolus of vasopressor administered depending on whether there was a negative or positive gradient of SBP changes, respectively.ObjectiveThe aim of this pilot study was to investigate the feasibility of the ADIVA algorithm.DesignA prospective pilot study.SettingSingle obstetrics and gynaecology centre in Singapore.PatientsWomen undergoing elective caesarean delivery under spinal anaesthesia.InterventionAutomated administration of ephedrine or phenylephrine based on changes in blood pressure and heart rate (via the ADIVA algorithm) detected on continuous noninvasive haemodynamic monitoring using noninvasive continuous haemodynamic monitor (Nexfin).Main Outcome MeasuresThe primary outcome was the incidence of hypotension, defined as SBP less than 80% of baseline. The secondary outcome measures were reactive hypertension, total vasopressor requirement, maternal and neonatal outcomes and system performance.ResultsForty-five women were recruited. Thirty-one women (69.9%) had at least one reading of hypotension. SBP was within ±20% of the baseline in a mean ± SD of 79.7 ± 17.6% of measurements. Forty-four (97.8%) women required phenylephrine before delivery, while 15 (33.3%) required ephedrine. No rescue medications were required. Three women (6.7%) had nausea and two (4.4%) vomiting. All neonates had APGAR scores of 9 at 5 min.ConclusionThe ADIVA system, with noninvasive continuous haemodynamic monitoring, was able to maintain maternal SBP within ±20% of baseline for the vast majority of the measurements. This system had good maternal and foetal outcomes with minimal intervention from the attending anaesthetist.Trial RegistrationNCT03620942.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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