Prevention of arterial hypotension during cesarean section under spinal anesthesia: trial of a baby norepinephrine protocol at the Owendo University Hospital Center (Gabon)

Abstract

Spinal anesthesia is a commonly used technique in cesarean section. This technique causes frequent maternal hypotension responsible for a reduction in placental perfusion rate causing fetal acidosis. Prophylactic vasopressor treatment is systematically recommended. Noradrenaline is today a molecule of choice. The objective of this work was to describe the benefit of using baby norepinephrine in the prevention of arterial hypotension in the context of cesarean section under spinal anesthesia. Methodology: Through a prospective observational study, parturients undergoing a planned or relative emergency cesarean section under spinal anesthesia during this period were included. Norepinephrine was administered by slow venous infusion at a rate of 0.028 to 0.057, or 4 to 10 drops/minute. Results: During the study period, 28 women were included. Their mean age was 30.1 ± 5.6. Scarred uterus (32%) and narrowed pelvis (25%) were the main indications. Parturients were classified according to the American Society of Anesthesia (ASA) as ASA1 in 82.1%. The systolic blood pressure recorded after the start of the baby norepinephrine infusion at the 1st minute, between the 5th and 15th minutes and between the 15th and 30th respectively between 100 and 140 mmHg in 71.4%, 85.7 % and 96.4% cases. Heart rate remained normal throughout norepinephrine administration. Conclusion: Low-dose norepinephrine ensures good hemodynamic stability perioperatively for cesarean section under spinal anesthesia.