Maternal hypotension during spinal anesthesia for caesarean delivery (original) (raw)
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Post-spinal anesthesia hypotension during cesarean delivery, a review article
Egyptian Journal of Anaesthesia, 2017
Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Prevention and treatment of post-spinal hypotension (PSH) in cesarean delivery has been frequently investigated. Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols; thus, the use of fluid loading as a sole method for prophylaxis might be not satisfactory for many anesthetists. Phenylephrine is the preferred vasopressor for prevention and management of PSH in most cases. Ephedrine may be more beneficial in patients with bradycardia, patients with uteroplacental insufficiency and pre-eclamptic patients. Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH with minimal cardiac side effects. The high incidence of PSH with most of the pharmacological and non-pharmacological methods suggests the need for multimodal protocols for prevention and management of this problem. PSH in cesarean delivery is a common daily situation facing all anesthetists; thus, future research should focus on simple and rapid protocols that can be easily applied by anesthetists with moderate and low experience with minimal need to complex devices or costly drugs.
Preventing spinal hypotension during Caesarean delivery: what is the latest?
British journal of anaesthesia, 2015
Spinal hypotension is common in women who receive spinal anaesthesia for Caesarean delivery, with an incidence of up to 71%. 1 Spinal hypotension can occur precipitously and, if severe, can result in important perinatal adverse outcomes, such as maternal nausea and vomiting, fetal acidosis and may be an important contributory factor for maternal death related to regional anaesthesia. 2 3 Mothers with pre-delivery hypovolaemia may be at risk of cardiovascular collapse because the sympathetic blockade may severely decrease venous return. As a consequence, prevention of spinal hypotension has been a key research area within the field of obstetric anaesthesia.
Pakistan Journal of Medical and Health Sciences, 2022
Background: Hypotension following spinal block can be reduced or minimized prophylactically left lateral uterine displacement, volume loading with crystalloid solutions, phenylephrine infusion or ephedrine administration. Fluid pre loading does not negate the hypotension entirely but decreases the risk. This however is time consuming and vasopressors are often required to correct associated hypotension. Prophylactic ephedrine administration lowers the risk of hypotension at the expense of reactive hypertension if spinal block fails and subsequent conversion to general anesthesia. Aim: To compare the efficacy of prophylactic use of ephedrine versus fluid (Hartmann's solution) preload in women undergoing cesarean section under spinal anesthesia at a teaching hospital. Study design: Randomized controlled trial. Place and duration of study: Department of Anesthesiology, Nishtar Hospital Multan, from 1 st March 2020 to 30 th September 2020. Methodology: A total of 100 women, twenty to forty years of age undergoing cesarean section were included. Patients with known hypertension, eclampsia, bleeding diathesis, injection site infection, deformity of spinal column or patients having valvular heart diseases were excluded. Group A women were given prophylactic ephedrine while Group B were given fluid (Hartmann's solution) preload. After induction of spinal anesthesia continuous blood pressure monitoring was done for fifteen minutes to diagnose hypotension. Hypotension was noted and recorded by the researcher. Results: The mean age of women in group A was 28.04±6.07 years and in group B was 28.26±6.13 years. Majority of the patients, 56, were between twenty to thirty years of age. The mean BMI in group A was 29.06±3.37kg/m2 and in group B was 29.38±3.50 kg/m 2. Efficacy of prophylactic use of ephedrine to prevent hypotension was observed in 37(74%) patients and in 25(50%) patients in fluid preload group undergoing cesarean sections under spinal anesthesia. Conclusion: The frequency of hypotension is lower in parturient undergoing spinal anesthesia with prophylactic use of ephedrine as compared to women having fluid (Hartmann's solution) preload.
Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section
International journal of obstetric anesthesia, 2000
Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated in a prospective observational study the influence of injection speed on maternal hypotension. Hyperbaric bupivacaine 10 mg, sufentanil 2 microg and morphine 200 microg (total volume 4 mL) were injected either quickly (<15 s) or slowly (=120 s) in 50 women scheduled for elective cesarean section. Hypotension (systolic arterial pressure (SAP) <100 mmHg or <70% of baseline) was promptly treated with 5 mg ephedrine boluses. Slow injection significantly reduced the incidence of hypotension (68% in the 120 s group and 92% in the other, P =0.03). In addition, onset of hypotension was delayed, had a shorter duration and required less ephedrine for hypotension in the 120 s group (11.6 mg vs. 19.6 mg, P =0.019). Anesthesia was satisfactory for all women. We conclude that a 2 mL/min injection rate may be a simple and effective way to reduce the incidence and severity of hypotension ...
Jurnal Ners dan Kebidanan, 2022
Hypotension is a complication that often occurs in section Caesarea with spinal anesthesia. Severe hypotension poses serious risks to the mother (such as loss of consciousness) and the baby (such as oxygen deprivation and brain damage). So to prevent hypotension, it can be done by giving crystalloid or colloid fluid therapy after spinal anesthesia is carried out. Articles were searched using 3 databases (PubMed, Pro-Quest, and Google scholar) with a randomized controlled trial research method. The literature was limited between 2010 and 2019. Seven articles with average results on administration of both preloaded and concomitant crystalline and colloidal fluids could reduce the incidence of hypotension, but for this technique Hypotension could not be completely reduced and should be used with Vasopresor. The incidence of hypotension after spinal anesthesia should be treated immediately to prevent injury to the kidneys, heart, and brain by giving oxygen and increasing the rate of infusion (colored) of 100 ml of colloid or crystalloid fluid within the first 5 minutes or less for improving blood pressure. If blood pressure is still low after fluids are given, a vasoconstrictor such as ephedrine 5-10 mg can be gradually given
2014
Spinal anesthesia is a common method of anesthesia in cesarean section and hypotension is the most common side effect of this method. The aim of this study is comparison between effects of ephedrine and distilled water on hypotension in patients under elective cesarean section with spinal anesthesia. This randomized clinical trial study included patients scheduled for elective cesarean section under spinal anesthesia. In this study 82 patients divided into two groups and they were injected subcutaneously randomly with 10 mg ephedrine (2 cc) or distilled water (2 cc). The patients hydrated 10-20 cc/kg before spinal anesthesia. After installation of cardiac lids and pulse oximetry, their blood pressure measured and recorded in 5 min before and 5, 10, 15, 30 min after spinal anesthesia. The Patients were received intravenous ephedrine if hypotension (hypotension was enumerated in blood pressure less than 90/60 mm Hg) was occurred. Diastolic hypotension was significantly occurred in ephedrine group was less than distilled water group in 30 min after spinal anesthesia (P=0.046), but there was no significant difference between two groups in other earlier times. Prophylactic subcutaneous injection of ephedrine can effectively prevent diastolic hypotension after spinal anesthesia. [Ghanei M, Sahraei R Jahromi AS. The Prevention Of Systemic Hypotension In Caesarean Section By Subcutaneous Injection Of Ephedrine Before Spinal Anesthesia. Life Sci J 2014,11(6):320-322] (ISSN:1097-8135). http://www.lifesciencesite.com. 43
Anesthesia and Analgesia, 2002
This quantitative systematic review compared the efficacy and safety of ephedrine with phenylephrine for the prevention and treatment of hypotension during spinal anesthesia for cesarean delivery. Seven randomized controlled trials (n ϭ 292) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were maternal hypotension, hypertension and bradycardia, and neonatal umbilical cord blood pH values and Apgar scores. For the management (prevention and treatment) of maternal hypotension, there was no difference between phenylephrine and ephedrine (relative risk [RR] of 1.00; 95% confidence interval [CI], 0.96 -1.06). Maternal bradycardia was more likely to occur with phenylephrine than with ephedrine (RR of 4.79; 95% CI, 1.47-15.60). Women given phenylephrine had neonates with higher umbilical arterial pH values than those given ephedrine (weighted mean difference of 0.03; 95% CI, 0.02-0.04). There was no difference between the two vasopressors in the incidence of true fetal acidosis (umbilical arterial pH value of Ͻ7.2; RR of 0.78; 95% CI, 0.16 -3.92) or Apgar score of Ͻ7 at 1 and 5 min. This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women.
Role of Ephedrine for Management of Hypotension During Spinal Anaesthesia for Caesarean Delivery
Journal of the Bangladesh Society of Anaesthesiologists
Background: Hypotension during spinal anaesthesia for caesarean section remains a common scenarioin our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Ephedrinehas been the drug of choice for more than 30 years in the treatment of spinal anesthesia induced maternalhypotension. It has a good safety record, ready availability, and familiarity to most anesthesiologists. Aims: To determine the efficacy and safety of prophylactic bolus dose of 0.5 mg/kg intravenous ephedrinefor the prevention of hypotension during spinal anesthesia for cesarean delivery. Methods: It was designed a randomized, double-blinded study. Patients were randomly allocated intotwo groups: ephedrine group (n=30) and control group (n=30). Intravenous preload of 15 mL/kg lactatedRinger’s solution was given. Shortly after the spinal injection, ephedrine0.5 mg/kg or saline was injectedintravenous for 60 sec. Results: The mean of highestand lowest heart rate in the ephedrin...