The Management of Spinal and Epidural Anesthesia-related Hypotension in the United States during C-section Childbirth

Abstract

Currently, neuraxial analgesia is the most effective method of analgesia during childbirth. However, the leading side effect, hypotension, makes it crucial to understand the existing treatments for spinal anesthesia-induced hypotension. This study attempts to elucidate anesthesia-induced hypotension and existing therapies. Researchers performed a scoping review using PubMed and Rayyan to select articles. Inclusion criteria were peer-reviewed articles written in English within the last five years, and nulligravida/primigravida women under 35 years old who reside in the USA. Researchers revealed the different means of treatment to reduce the incidence of spinal anesthesia-induced hypotension in mothers during C-sections. Norepinephrine and epinephrine showed to be more effcacious in maintaining blood pressure while avoiding unfavorable sequelae for the mother following delivery. The study outcome of participants receiving fixed-rate infusions of either norepinephrine or phenylephrine favored the use of norepinephrine. These patients exhibit lower rates of bradycardia ( p=0.004), contributing to a lesser need for bolus rescue of atropine ( p=0.01). Using colloid solutions during C-section compared to crystalloid solutions also revealed a lower incidence of hypotension with a p-value of < 0.00001. Modalities such as wrapping and subsequent elevation of the lower extremities also displayed a significantly higher systolic and diastolic blood pressure and ephedrine dose than the control group. Pharmacological treatment modalities are more effective than non-pharmacological treatments at preventing maternal hypotension. Epinephrine was the most effective treatment for maintaining maternal blood pressure, heart rate, and cardiac output. Further studies should be done to determine the optimal epinephrine dosage. There was no funding provided for this research. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.