Abstract
Background: Spinal Anaesthesia (SA) is the most common preferred anaesthesia technique for Caesarean section (CS), because of its superior analgesia, favourable relaxation and decreased risk of complications over general anaesthesia1,2,3,4. Incidence of hypotension after spinal anaesthesia is highest in Caesarean section, and it can be significantly severe so that it can jeopardize the mother and foetus5,6,7,8,9,10,11,12,13. So early detection and prevention of hypotension is of atmost importance for better maternal and foetal outcome. This study aim to assess the incidence of spinal anaesthesia induced hypotension in parturients and confirm the existing risk factors and also to identify new risk factors if any in a population, where published studies are nil.
Methods: After obtaining approval from Research committee and institutional ethical committee a total of 200 patients who satisfied the inclusion and exclusion criteria were included in the study and evaluated for the development of hypotension after spinal anaesthesia. The population was divided in to two groups with and without hypotension after spinal anaesthesia for Lower segment caesarean section (LSCS). The two groups were then compared with respect to their demographic, maternal, anaesthetic and foetal variables to see whether any association exist with the development of maternal hypotension.
Results: In the present study the proportion of hypotension following spinal anaesthesia for CS was 54.5% (109/200). Univariate analysis identified 3 maternal risk factors such as age>30 years, ASA class II, and BMI>30kg /m2. Anaesthesia related variable identified was sensory block height ≥ T5.Neonatal birth weight >2.5.kg was found as the significant foetal variable.
Conclusion: The incidence of maternal hypotension in the parturient after SA still remains high. Knowledge of the incidence and risk factors as well as timely intervention will definitely contribute to early detection and prevention of severity maternal hypotension.
Keywords: Spinal anaesthesia (SA), Caesarean section (CS), Hypotension, Risk factors.
References
- Aboud TK, Nagappala S, Murakawa K, et al. Comparison of the effects of general and regional anaesthesia for caesarean section on neonatal neurologic and adaptive capacity scores. Anesth Analg 1985; 64:
- Shyken J M, et al. A comparison of the effect of epidural, general and no anaesthesia on funic acid-base value of stage of labour and type of delivery. Am J Obstet Gynecol 1990; 163:
- Hodgkinson R, Batt M, Kim SS, et al. Neonatal neurobehavioral tests following caesarean section under general and spinal anaesthesia. Am J Obstet Gynecol 1978; 132:
- HS, Merhej A, Dabbas MA, Hindawi IM. Spinal versus general anaesthesia for elective caesarean delivery: a prospective comparative study. Clin Exp Obstet Gynecol 2001; 246-8.3.
- Juhani TP, Hannele H. Complications during spinal anaesthesia for caesarean delivery: a clinical report of one year’s experience. Reg Anesth 1993; 18:
- Schinider and Levinsons Text book of obstetric anaesthesia. 1,3-15.
- D. Millers anaesthesia 7th edin-obstetric anaesthesia .
- Corke BC, Datta S Ostheimer GW, et al. Spinal anaesthesia for caesarean section: the influence of hypotension on neonatal outcome. Anaesthesia 1982; 37:
- Robson SC Samson G Boys RJ, Rodek C Morgen B. Incremental spinal anaesthesia for elective caesarean section; maternal and fetal haemodynamic effects. Br J of Anaesthesia 1993; 70(6):634-638.
- Robson SC, Boy RJ, Rodek C, Morgen B. Maternal and fetal haemodynamic effect of spinal and extradural anaesthesia for elective caesarean section. Br J Anaes. 1992; 68(1): 54-59.
- Kyokong and Charulaxanan et al incidence and risk factors of hypotension and bradycardia associated with spinal anaesthesia.
- Prospective study of hypotension and bradycardia during spinal anaesthesia with bupivacaine: incidence and risk factors, part two, JMed Assoc Thai 2007 March 90:492-501.
- Ohpasanon P, Chinachoti T, Sriswasdi P, Srichu S. Prospective study of hypotension after spinal anesthesia for caesarean section at Siriraj Hospital incidence and risk factors, part 2. J Med Assoc Thai 2008; 91: 675-80.
- Parent study of incidence and risk factors of hypotension after Spinal Anesthesia for Caesarean Section -2004 at Siriraj Hospital. J Med Assoc Thai 2006 Aug 89(8)1127-32. Chumpathong et al.
- Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for caesarean section. J Med Assoc Thai 2008; 91:181-7.
- Juhani TP, Hannele H. Complication during Spinal anesthesia for cesarian delivery: a comparison of two doses. Reg Anesth 1995; 20:
- Roberts SW, Leveno KJ, Sidawi JE, et al. Foetal acidemia associated with regional anesthesia for elective caesarean delivery. Obstet Gynecol 1995; 85:
- Cousins and Bridenbaughs 4th edin.24; 532-563.
- Hypotension after spinal anesthesia for caesarean section: identification of risk factors using an anaesthesia information management system:- Journal of clinical monitoring and computing (2009) 23:85-92 BRenck and Hartmann et al.
- Bose M, Kini G, Krishna HM. Comparison of crystalloid preloading versus crystalloid co-loading to prevent hypotension and bradycardia following spinal anaesthesia. J Obstet Anaesth Crit Care 2012; 2:10-5.
- S and Roth et al. Definition of hypotension after spinal anaesthesia for caesarean section literate research. Acta Anaesthesiologic a Scandinavica 2010; 54-909-21.
- Apgar, Virginia(1953).”A proposal for a new method of evaluation of the new born infant”. Res.Anesth.Analg.32 (4):260-267. PMID 13083014.
- Mar Carthur. A etal.Solving the problem of spinal induced hypotension in obstetric anaesthesia.Can.j.Anae:2002,49;536-9.
Corresponding Author
Dr Sheela .P
Professor, Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Medical College PO, Thiruvananthapuram, Kerala, India, Pin 695011
Phone numbers: 9387902123, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.198
