The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20180919Keywords:
Bupivacaine, Caesarean section, Cardiovascular effects, Parturient, Spinal anaesthesiaAbstract
Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.
Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.
Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.
Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone.
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References
Jenkins JG, Khan MM. Anaesthesia for caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003;58(11):1114-8.
Afolabi BB, Lesi FE. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. 2012 Oct;10:CD004350.
Michie AR, Freeman RM, Dutton DA, Howie HB. Subarachnoid anaesthesia for elective caesarean section. Anaesthesia. 1988;43:96-9.
Rollins M, Lucero J. Overview of anesthetic considerations for cesarean delivery. Br Med Bull. 2012;101:105-25.
Casey WF. Spinal anaesthesia-a practical guide. Update in Anaesthesia. 2000;12:1-7.
Ankcorn C, Casey WF. Spinal anaesthesia-a practical guide. Update in Anaesthesia. 1993;3:2-15.
Gogarten W. Spinal anaesthesia for obstetrics. Best Pract Res Clini Anaesthesiol. 2003;17:377-92.
Grant GJ, Hepner David L, Barss VA. Neuraxial analgesia and anesthesia for labor and delivery: drugs. Available at http:// www.uptodate.com/home 2011. Accessed on 22 November 2017.
Mohta M. Ropivacaine: Is it a good choice for spinal anesthesia? J Anaesthesiol, Clin Pharmacol. 2015;31(4):457-458.
Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery: A comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;101:705-10.
Corke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for caesasean section. The influence of hypotension on neonatal outcome. Anaesthesia. 1982;37:658-62.
Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesthesia Progress. 2006;53(3):98-109.
Cousins MJ, Bridenbaugh PO. Neural blockade in clinical anesthesia and management of pain. Lippincott Williams & Wilkins;1998.
Bano F, Sabbar S, Zafar S, Rafeeq N, Iqbal MN, Haider S, et al. Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section. JCPSP 2006;16(2):87-90.
Roberts FL, Brown EC, Davis R, Cousins MJ. Comparison of hyperbaric and plain bupivacaine with hyperbaric cinchocaine as spinal anaesthetic agents. Anaesthesia. 1989;44:471-4.
Karaman S, Kocabas S, Uyar M, Hayzaran S, Firat V. The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol. 2006;23:285-91.
Atalay C, Aksoy M, Aksoy AN, Dogan N, Kürsad H. Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects. J Int Med Res. 2010;38(5):1626-36.
Emmett RS, Cyna AM, Andrew M, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2001;(3):CD002251.
Sharma SK, Gajraj NM, Sidawi JE. Prevention of hypotension during spinal anaesthesia: a comjparison of intravascular administration of hetastarch versus lactated Ringer’s solution. Anaesth Analg. 1997;84:11-4.
Dahlgren G, Granath F, Wessel H, Irestedt L. Prediction of hypotension during spinal anesthesia for cesarean section and its relation to the effect of crystalloid or colloid preload. Int J Obstet Anesth. 2007;16:128-34.
Kiran M, Hemant B, Sudhir KE, Prakash CS. Evaluation of preloading and vasoconstrictors as a combined prophylaxis for hypotension during sub arachnoid anaesthesia. Ind J Anaesth. 2004;48(4):299-303.
Baraka AS, Taha SK, Ghabach MB, Sibaii AA, Nader AM. Intravascular administration of polymerized gelatin versus isotonic saline for prevention of spinal-induced hypotension. Anesth Analg. 1994;78:301-5.
Vercauteren MP, Hoffman, Coppejans HC, Van Steenberge AL, Adriaensen HA. Hydroxyethylstarch compared with modified gelatine as volume preload before spina anaesthesia modified gelatine as volume preload before spinal anaesthesia for caesarean section. Br J Anaesth. 1996;76:731-3.
Critchley LAH. Hypotension, subarachnoid block and the elderly patient. Anaesthesia. 1996;51:1139-43.