CLINICAL EFFECTIVENESS OF A HEMODYNAMIC RISK-BASED PERSONALIZED PROTOCOL DURING COMBINED SPINAL-EPIDURAL ANESTHESIA

Abstract

Objective. To evaluate the clinical effectiveness of a personalized management protocol based on preoperative stratification of hemodynamic instability risk in multiparous pregnant women with anemia undergoing cesarean delivery under combined spinal-epidural anesthesia. Materials and methods. The prospective comparative study included 146 pregnant women with anemia of different etiologies. Seventy-two patients in the control group received standard anesthetic management, whereas 74 patients in the intervention group were managed using the SHIGUAN integral risk score followed by risk-adapted fluid and vasopressor support. Results. Personalized management was associated with more stable perioperative hemodynamics and a shorter time to stabilization. The incidence of intraoperative hypotension decreased from 43.1% to 24.3% (p=0.009; OR=0.43; 95% CI 0.22-0.85). Vasopressor, fluid and transfusion requirements were also reduced. Conclusion. Preoperative hemodynamic risk stratification followed by individualized perioperative support is associated with a lower incidence of hemodynamic instability during combined spinal-epidural anesthesia in multiparous pregnant women with anemia.