The Effectiveness Of Non Invasive Hemodynamic Parameters In Detection Of Spinal Anesthesia Induced Hypotension During Cesarean Section

Abstract

ABSTRACT Introduction: Hypotension is the most frequent consequence of spinal anesthesia in cesarean section. It results in harmful effects on mother and newborn. Aim: This study aim was to evaluate the correlation of positional changes in hemodynamic (heart rate and blood pressure) measured before spinal anesthesia in anticipation of occurrence of hypotension throughout cesarean delivery. Methods: 100 ASA grade I parturient were selected for this prospective observational study. Preoperative sociodemographic data, parity, and hemodynamic parameters were recorded including changes in systolic, diastolic, mean arterial blood pressure, and heart rate after positional shift from supine to lateral and sitting positions. Intraoperative, occurrence of hypotension was noted. Results: With hypotension as the dependent variable, the age, parity, heart rate at supine position, and changes in (heart rate, systolic, diastolic and mean arterial blood pressure) from supine to lateral position, and from supine to sitting position had high statistical significant negative correlation with blood pressure as P value <.05. Multivariate logistic analysis to assess predictors of hypotension concluded that changes in hemodynamic variable from supine to lateral position only significant predictor were (∆ heart rate, ∆ diastolic and ∆ mean blood pressure), and changes in hemodynamic variable from supine to sitting position only significant predictor were (∆heart rate and ∆ diastolic blood pressure). Discussion: Elevated sympathetic activity before neuraxial anesthesia was associated with higher risk for post-spinal hypotension. The great variability in hemodynamic after positional change indicates higher sympathetic activity to blood vessels. The high rise in the autonomic activity, the higher the risk for post-spinal hypotension Conclusion: Age, parity, and positional changes in hemodynamic were correlated with blood pressure reading after spinal anesthesia during cesarean delivery.