Hypotension In Cesarean Section Research Articles

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

A Double-Blinded Prospective Randomized Control Study of Preoperative Administration of Intravenous Mephentermine Vs Intramuscular Mephentermine in Preventing Post-Spinal Hypotension in Caesarean Section

Context: Mephentermine by intramuscular route prevents post-spinal anesthesia hypotension. However, the intravenous route had not been tried earlier for this prophylactic purpose. Aims: Comparing the safety and efficacy of intravenous and intramuscular routes of mephentermine in preventing maternal hypotension during cesarean section (CS). The primary objective was to compare the incidences of hypotension. Methods and Material: ASA II term parturients posted for CS were randomized into three groups. Group I received intravenous mephentermine 10 mg just before spinal and 1 ml normal saline (NS) by intramuscular route 10 minutes before spinal. Group M received intramuscular mephentermine 15 mg 10 minutes before spinal and 1 ml NS by the intravenous route just before spinal. Group C received 1 ml NS intramuscularly 10 minutes before spinal and 1 ml NS by the intravenous route just before spinal. The vital parameters, episodes of hypotension, adverse events, and neonatal parameters were assessed. Results: During midterm analysis, it was found that Group I had significantly higher adverse effects, so data collection was stopped, with a total intake of 25 patients in Group M, 22 patients in Group I, and 20 patients in Group C, respectively. The incidence of hypotension was less with the use of IM (8%) and IV (22.7%) mephentermine compared to the control group (P value: <0.05). Group I had significantly more adverse events like headache (59%), chest pain (36.36%), and ST changes compared to other groups (P value: <0.001). Conclusions: We conclude that the intramuscular route is better for preventing post-spinal hypotension in cesarean section with lesser maternal side effects and a better Apgar score.

The effect of adding dexmedetomidine or dexamethasone to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section.

Many strategies are available to prevent spinal-induced hypotension in cesarean section, especially the use of a low dose of spinal anesthesia combined with adjuvants. This study investigated the effect of adding either dexmedetomidine or dexamethasone to the intrathecal bupivacaine-fentanyl mixture on the postoperative analgesia duration, after elective cesarean section. This prospective, randomized, double-blind study was conducted on 90 full-term parturients undergoing elective cesarean section, who were randomly distributed into three groups. They all received spinal anesthesia with the bupivacaine-fentanyl mixture (2.5 ml), in addition to 0.5 ml normal saline (control group), 5 μg dexmedetomidine dissolved in 0.5 ml normal saline (dexmedetomidine group), or 2 mg dexamethasone (dexamethasone group). The time to the first request of morphine rescue analgesia was recorded, in addition to the total dose of morphine consumed in the first 24 h after surgery, the postoperative numerical rating score (NRS), and maternal and fetal outcomes. As compared to the control group and the dexamethasone group, the use of dexmedetomidine as an additive to the bupivacaine-fentanyl mixture significantly prolonged the time to the first request of rescue analgesia, decreased postoperative morphine consumption, and decreased the pain score 4 and 6 h after surgery. There was an insignificant difference between the control and dexamethasone groups. The use of dexmedetomidine as an additive to bupivacaine-fentanyl mixture in spinal anesthesia for cesarean section prolonged the postoperative analgesia and decreased the postoperative opioid consumption in comparison to the addition of dexamethasone or normal saline.

The Use of End-Tidal CO2 and Integrated Pulmonary Index to Predict Postspinal Hypotension in Cesarean Section.

Early diagnosis and treatment of postspinal hypotension (PSH) in obstetric anaesthesia reduces the risk of maternofetal complications. In this study, the effect of EtCO2 and the integrated pulmonary index (IPI) in predicting PSH was investigated. Patients scheduled for cesarean section under spinal anaesthesia were included. The Capnostream 35 respiratory monitor (Medtronic, Inc., Dublin, Ireland) was used for EtCO2 and IPI. PSH developed in 52 (63.4%) of the 82 patients. EtCO2 and IPI values decreased significantly compared with baseline values in patients who developed PSH. There were statistically significant differences in EtCO2 (p = 0.001) and the IPI change (p = 0.045) in patients who developed PSH compared with those who did not. It was found that the EtCO2 difference had an independent effect on predicting PSH (p < 0.05), whereas the IPI difference did not (p > 0.05). One unit decrease in EtCO2 from the baseline increased the risk of PSH by 3.3 times. ROC curve analysis showed that the magnitude of change in EtCO2 was diagnostic for predicting PSH (AUC: 0.90 (0.83-0.97; p < 0.001)). IPI showed no predictive value for postspinal hypotension in cesarean section. However, EtCO2 monitoring, which is non-invasive and real-time monitoring, can be used to predict postspinal hypotension.

Retracted: Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates.

[This retracts the article DOI: 10.1155/2022/2468114.].

Exploring the predictive value of combined ultrasound parameters for spinal anesthesia-induced hypotension in cesarean section: a prospective observational study

BackgroundProphylactic vasopressor infusion can effectively assist with fluid loading to prevent spinal anesthesia-induced hypotension. However, the ideal dose varies widely among individuals. We hypothesized that hypotension-susceptible patients requiring cesarean section (C-section) could be identified using combined ultrasound parameters to enable differentiated prophylactic medical interventions.MethodsThis prospective observational trial was carried out within a regional center hospital for women and children in Sichuan Province, China. Singleton pregnant women undergoing combined spinal-epidural anesthesia for elective C-sections were eligible. Women with contraindications to spinal anesthesia or medical comorbidities were excluded. Velocity time integral (VTI) and left ventricular end-diastolic area (LVEDA) in the supine and left lateral positions were measured on ultrasound before anesthesia. Stroke volume, cardiac output, and the percentage change (%) in each parameter between two positions were calculated. Vital signs and demographic data were recorded. Spinal anesthesia-induced hypotension was defined as a mean arterial pressure decrease of > 20% from baseline. The area under the receiver operating characteristic curve (AUROC) was used to analyze the associations of ultrasound measurements, vital signs, and demographic characteristics with spinal anesthesia-induced hypotension. This exploratory study did not have a predefined outcome; however, various parameter combinations were compared using the AUROC to determine which combined parameters had better predictive values.ResultsPatients were divided into the normotension (n = 31) and hypotension groups (n = 57). A combination of heart rate (HR), LVEDAs, and VTI% was significantly better at predicting hypotension than was HR (AUROC 0.827 vs. 0.707, P = 0.020) or LVEDAs (AUROC 0.827 vs. 0.711, P = 0.039) alone, but not significantly better than VTI% alone (AUROC 0.827 vs. 0.766, P = 0.098).ConclusionThe combined parameters of HR and LVEDAs with VTI% may predict spinal anesthesia-induced hypotension more precisely than the single parameters. Future research is necessary to determine whether this knowledge improves maternal and neonatal outcomes.Trial registrationChiCTR1900025191.

Hemodynamic maintenance with norepinephrine in caesarean section under spinal anesthesia and its fetal outcome: a systematic review

Background: Postspinal hypotension is a frequent maternal complication in caesarean delivery under neuraxial anesthesia. Anesthesiologists have been using different vasopressors to maintain hemodynamics. Recent studies suggested beneficial effects of norepinephrine on maternal blood pressure and cardiac output, but little evidence exist on the neonatal outcome. Objectives: This systematic review summarises recent evidence on neonatal outcome, such as umbilical arterial pH and base excess, after administration of norepinephrine during caesarean section. Methods: A literature search on PubMed from 2010 to 2022 was performed and every article was reviewed on neonatal outcome, as primary endpoint and on maternal hemodynamics, as secondary endpoint. A total of 15 randomised controlled trials were included. Results: Studies using a prophylactic infusion of norepinephrine show normal fetal blood gases. No evidence of fetal stress (pH &lt; 7,20, base excess &lt; -6) was assessed in the studies. Norepinephrine succeed in maintaining maternal hemodynamics. It is responsible for less bradycardia than phenylephrine and less tachycardia than ephedrine. Conclusion: Our study suggests that norepinephrine, preferably as prophylactic infusion, is a safe vasopressor to prevent postspinal hypotension in caesarean section. No signs of fetal acidosis could be demonstrated in the recent studies.

Anesthesia characteristic of an algorithm of bupivacaine dose based on height in caesarean section under spinal anesthesia: a retrospective cohort study

BackgroundAn algorithm of bupivacaine dose based on height is applied to reduce maternal hypotension in caesarean section under spinal anesthesia. This study is designed to further verify whether the algorithm of bupivacaine dose based on height is suitable.MethodsThe parturients were grouped according to height. The comparison of anesthesia characteristic among subgroups was carried out. The univariate and multivariate binary logistic regressions were executed to reanalyze the interference factor for the anesthesia characteristic.ResultsWhen the dose of bupivacaine was adjusted by using the height based dosing algorithm, except for weight (P < 0.05), other general data did not present statistical changes with height (P > 0.05); the incidences of complications, characteristics of sensory or motor block, quality of anesthesia and neonatal outcome were of no statistical difference among parturients with different heights (P > 0.05); the height, weight and body mass index were not related with maternal hypotension (P > 0.05). When the dose of bupivacaine is constant, except for weight and body mass index (P > 0.05), the height was the independent risk factor for maternal hypotension (P < 0.05).ConclusionsExcept for weight and body mass index, the height has an influence on the bupivacaine dose. It is reasonable that the bupivacaine dose is adjusted by using this dosing algorithm based on height.Trial RegistrationThis study was registered at http://clinicaltrials.gov (13/04/2018, NCT03497364).

Special maternal care bundle to attenuate post-spinal hypotension in cesarean section: A randomized controlled clinical trial

ABSTRACT Background This study aimed to assess the safety and efficacy of a special maternal care bundle as an alternative technique for the attenuation of hypotension following spinal anesthesia in parturients scheduled for CS. Methods This double-blinded, parallel-group, randomized trial enrolled 138 adult parturients who were scheduled for CS under spinal anesthesia. The patients were randomly allocated to two groups. In the care bundle group, 68 participants received a co-load of lactated Ringer’s solution and ondansetron infusion during administration of spinal anesthesia with a slow rate intrathecal bupivacaine injection and a V-shaped supine position. While in the best practice group, 70 participants received a co-loaded lactated Ringer’s solution during spinal anesthesia with early use of vasopressors and a left uterine tilting position. The primary outcome was the total ephedrine consumption. Secondary outcomes included the mean arterial blood pressure, heart rate, atropine usage, complications such as dizziness, nausea, and vomiting, as well as the baby’s Apgar score. Results Special maternal care bundle significantly reduced the need and the total dose of ephedrine (P = 0.042). The mean arterial blood pressure was significantly less affected by maternal bundle care, but the reduction in heart rate, the need for atropine, the incidence of dizziness, nausea, vomiting, and the Apgar score were comparable in both groups. Conclusion The special maternal care bundle including co-load of lactated ringer, ondansetron 4 mg IV infusion, slow intrathecal injection and v-shaped positions can reduce the incidence of hypotension resulting from spinal anesthesia and ephedrine usage during CS.

Perfusion Index and Positional Blood Pressure Changes as Preoperative Predictors for Post-Spinal Hypotension in Caesarean Section: An Observational Study

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Battling Hypotension in Cesarean Section

Perhaps the greatest day in a mother's life is the birth of her child. As a father of two, I will never forget those two drastically different, yet equally beautiful moments. In each circumstance, the obstetricians, nurses, anesthesia providers, and technicians all worked seamlessly to provide a safe and enjoyable childbirth experience for our new and growing family. One key element of the childbirth experience is maternal pain control. Depending on several factors, the parturient may receive an epidural, a spinal, a combined spinal/epidural, IV analgesics or perhaps nothing at all. One key commonality after any anesthetic administration is its propensity to cause hypotension, which is usually most profound after spinal anesthesia (SA). SA is the preferred method during elective cesarean sections due to the rapid and predictable onset and duration of action of local anesthetics injected directly into the cerebrospinal fluid. Immediately after SA is administered, the patient is helped to lay supine which assists the hyperbaric local anesthetic to move with gravity and rise cephalad from the lower lumber injection site (L3-L5) towards the desired T4 vertebra. While marching up those 12 dermatome levels, the local anesthetic quickly begins to attenuate sympathetic tone at every level along the way. Depending on the health of the patient's cardiovascular system, intravascular volume status and other factors, the sympathectomy and subsequent vasodilation can result in significant and symptomatic hypotension, causing a vast array of symptoms such as maternal nausea, vomiting, dizziness, and cardiovascular collapse as well as fetal acidosis and decreased Apgar scores. Preanesthesia fluid boluses are commonly administered in hopes to increase intravascular volume and lessen the severity of hypotension, but its effectiveness is unreliable. Acute arterial vasodilation is the primary cause of hypotension after SA. Intravenous vasoactive medications such as phenylephrine and ephedrine offer the fastest and most effective means of arterial vasoconstriction and subsequent correction of blood pressure; yet healthcare providers will always continue to search for alternative and less invasive methods of preventing and/or treating hypotension after SA.

Effect of Crystalloid or Colloid Fluid Loading and Vasopressor Pre-Treatment on the Timing of Hypotension in Cesarean Section with Subarachnoid Block

BACKGROUND: Cesarean section (C-section) is the most frequently performed surgery in obstetrics, generally using subarachnoid block (SAB) or epidural block for anesthesia. The previous studies have shown the effectiveness of fluid loading and vasopressor pretreatment in preventing maternal hypotension (decreased blood pressure), the most common side effect of SAB. However, the timing of hypotension in response to these treatments has not been analyzed. AIM: This study therefore aimed to compare the effects of crystalloid or colloid fluid loading and vasopressor pre-treatment on the timing of hypotension in cases of C-section under SAB anesthesia. METHODS: The study was a single-blind randomized controlled clinical trial with three treatment groups: Group I, 10 mL/kgBW crystalloid solution (Ringer’s lactate) loading 10 min before SAB; Group II, 5 mL/kgBW colloid fluid (gelatin) loading 10 min before SAB; and Group III, pretreatment with 0.1 mg/kgBW vasopressor (ephedrine) intravenous bolus just before SAB. RESULTS: Significant differences in mean blood pressure between groups were observed between the second and 8th min (p &lt; 0.05). Hypotension was observed in the crystalloid group within the first 5 min, while average blood pressure was relatively stable all groups after the first 10 min. In addition, hypotension occurred more frequently in the crystalloid group (nine subjects, 45%), compared with the colloid and vasopressor groups (two subjects per group, 10%; p &lt; 0.05). CONCLUSION: Hypotension occurred more rapidly and more frequently when crystalloid loading was utilized, compared with colloid loading or vasopressor pretreatment. Administration of colloid fluid loading and vasopressor pretreatment has been shown to prevent hypotension in SAB anesthesia.

A Prospective Randomized Study Comparing the Bolus Doses of Norepinephrine and Phenylephrine for the Treatment of Spinal Induced Hypotension in Cesarean Section.

Background: Spinal anesthetic-induced hypotension is the most worrisome complication for patients undergoing cesarean section under spinal anesthesia. The present study compares norepinephrine and phenylephrine bolus for the treatment of hypotension during spinal anesthesia for cesarean section.Methods: One hundred twenty- six women aged between 22 and 40 years with singleton pregnancy classified to the American Society of Anesthesiologists (ASA) physical class I and II posted for elective cesarean section under spinal anesthesia were randomly divided into two groups of 63 each. Group I patients received phenylephrine 50 mcg (microgram) as an intravenous bolus, and Group II received 4 mcg of norepinephrine as an intravenous bolus to treat spinal hypotension.Results: On comparing the demographic data of the patients in terms of age, weight, height, ASA Grade, level of block and surgery time no significant differences were found between the groups. Similarly, the fetal parameters were found to be not significantly different between the groups. However, the number of bolus doses of vasopressors required for the treatment of spinal-induced hypotension was significantly reduced in Group II (p=0.02). The frequency of bradycardia was found to be higher in patients who were given phenylephrine as compared to patients administered noradrenaline boluses (p=0.03). Five (7.93%) patients had shivering in Group I, while similar episodes were observed in 10 (15.87%) patients (p=0.05). Moreover, no significant difference was observed in comparing the heart rate and mean arterial pressure between the groups.Conclusion: Intermittent boluses of norepinephrine are found to be effective in the management of spinal‑induced hypotension during caesarean section.

A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

Objective: The injection rate of the local anesthetic may affect the level and the time of onset of sensory block. The aim of this prospective study was to investigate the effects of two different injection rates of local anesthetic solution (0.5% heavy bupivacaine) on the onset of sensory block, and the incidence and the onset of hypotension in pregnant women undergoing spinal anesthesia for elective Cesarean delivery. Methods: A total of 67 patients were randomized into two groups: 120-second injection time (Group Slow; n = 33) and 15-second injection time (Group Fast; n = 34). Maximum level of sensory and motor block, time to sensory block at the level of T6, hemodynamic parameters, use of ephedrine and incidence of side effects were recorded at measurement time points. Results: Maximum level of the sensory block was similar in both groups. The time to achieve adequate and maximum sensory block level was shorter in Group Slow(S) (p = 0.004 and 0.037, respectively). Incidence of hypotension was similar, but hypotension occurred earlier in Group Fast(F) (p = 0.011). Requirement for ephedrine and incidence of nausea and vomiting was similar. Conclusions: This study reveals that 120-second injection duration during spinal anesthesia is associated with shorter time to achieve the maximum sensory block level and slower onset of hypotension. It means that prolonging the duration of local anesthetic injection to 120-seconds is advantageous compared with 15-seconds in caesarean section.

A Height-Based Dosing Algorithm of Bupivacaine in Spinal Anesthesia for Decreasing Maternal Hypotension in Cesarean Section Without Prophylactic Fluid Preloading and Vasopressors: A Randomized-Controlled Non-Inferiority Trial.

BackgroundThere is a high incidence of maternal hypotension in spinal anesthesia for cesarean section. The aim of the study is to investigate whether there is a height-based dosing algorithm of bupivacaine that provides adequate anesthesia with less maternal hypotension.MethodsThere were 2 groups of 280 parturients who did not receive prophylactic fluid preloading: Test and Conventional group. In Test group, a height based dosing algorithm was used to confirm the dose of bupivacaine in parturients without prophylactic vasopressors. In the Conventional group, a constant dose of bupivacaine was used. The complications and quality of anesthesia were evaluated.ResultsIn the Conventional group, the shorter participants had higher incidence of hypotension, faster sensory block time, and more participants with complete motor block (p = 0.030, 2.957 × 10−14, and 0.012). In the Test group, the incidence of hypotension, sensory block time, and number of participants with complete motor block did not change with height (p = 0.199, 0.617, and 0.209). The height-based dosing algorithm of bupivacaine decreased the incidence of hypotension (p = 0.004), induced lower sensory block level and less degree of motor block (p = 3.513 × 10−7 and 5.711 × 10−11). The quality of analgesia, quality of muscle relaxation, and degree of intraoperative comfort were similar in both groups (p = 0.065, 0.498, and 0.483).ConclusionsThe height influences the dose of bupivacaine in spinal anesthesia; without prophylactic fluid pre-loading and vasopressors, the height-based dosing algorithm of bupivacaine is suitable, and meets the cesarean section' requirement with less maternal hypotension.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT03497364.

Peripheral Perfusion Index: A Predictor of Post-Spinal Hypotension in Caesarean Section.

BackgroundEarly prediction of hypotension helps to decide appropriate prophylactic measures and, hence, safe anaesthesia for mothers and improved neonatal outcomes. Perfusion index (PI) measured from a standard pulse oximeter has shown positive results in the prediction of hypotension. This study aims to determine if PI can equally predict hypotension in parturients after administration of spinal anaesthesia at different time points.MethodsParturients posted for elective caesarean section belonging to the American Society of Anesthesiology II (ASA II) were divided into two groups based on baseline PI as group A <3.5 and group B ≥3.5. Fifty-six parturients were enrolled in the study. PI and blood pressure were monitored at baseline, every two minutes for 12 minutes and every five minutes until the end of the surgery, after administration of spinal anaesthesia with hyperbaric bupivacaine 10 mg. Incidence of hypotension was compared between groups at all time points of observation. Spearman’s rank correlation coefficient was determined to check the correlation between baseline PI and the number of episodes of hypotension. Receiver operating characteristic (ROC) curve was plotted to determine the ideal cut-off at different time points.ResultsBaseline PI significantly correlated with the number of episodes of hypotension (r-0.525). The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) as compared to those with PI <3.5 (33.33%). The incidence of hypotension at sixth, 10th and 37th minutes post-spinal anaesthesia administration was significantly higher in the group with PI ≥3.5. The sensitivity and specificity for the 3.5 cut-off of PI were 85.7% and 60%, respectively, at the 6th and 10th minute after spinal administration. A higher cut-off of 3.9 increases the specificity to 69% without much change in the sensitivity.Conclusion Parturients with PI >3.9 at baseline have a higher risk of hypotension in the initial 10-12 minutes following spinal anaesthesia during caesarean delivery.

Analysis of Risk Factors for Intraoperative Hypotension in Cesarean Section and Poor Prognosis of Neonates.

Objective To analyze the risk factors of intraoperative hypotension in cesarean section women and poor prognosis of neonates. Methods The clinical data of 1071 cesarean section women admitted to The Affiliated Jiangning Hospital of Nanjing Medical University from January 2021 to December 2021 were retrospectively analyzed. They were divided into hypotension group (n = 472) and normal control group (n = 599) according to whether there was hypotension during operation. The correlations between the clinical data of cesarean section and the occurrence of intraoperative hypotension and poor prognosis of neonates were analyzed by logistic regression analysis. Receiver operating curve (ROC) was drawn and the area under the curve (AUC) was calculated. Results Logistic regression analysis results showed that BMI ≥30 kg/m2, infant weight ≥3500 g, spinal anesthesia, puncture site L2-3, bupivacaine dose>10 mg, ropivacaine dose>50 mg, and perfusion index≥4 were the risk factor for intraoperative hypotension in cesarean section (p < 0.01) and BMI ≥30 kg/m2, umbilical cord around neck, spinal anesthesia, and perfusion index≥4 were risk factors for poor prognosis of neonates (p < 0.01). The AUC of ROC for BMI to diagnose intraoperative hypotension in cesarean section women was 0.6240 (95% CI: 0.59-0.66, p < 0.01), the sensitivity was only 30.20% (95% CI: 26.73%-35.02%), and the specificity was 87.65% (84.77%-90.04%), and the AUC of BMI for the diagnosis of poor prognosis of neonates was 0.5647 (95% CI: 0.5013-0.6280, p = 0.049), and the sensitivity was 51.19% (95% CI: 40.69%-61.59%), and the specificity was 64.34% (61.30%-67.26%). The AUC of perfusion index for the diagnosis of intraoperative hypotension in cesarean section women was 0.8333 (95% CI: 0.8081-0.8584, p < 0.01), the sensitivity was 94.49% (95% CI: 92.05%-96.21%), and the specificity was 73.12% (69.43%-76.52%); the AUC of perfusion index for the diagnosis of ROC with poor prognosis of neonates was 0.6164 (95% CI: 0.5538-0.6791, p < 0.01), the sensitivity was 70.24% (95% CI: 59.75%-78.96%), and the specificity was 50.86% (47.75%-53.97%). Conclusion The prediction model established by BMI, infant weight, anesthesia method, puncture site, anesthetic drug dose, and perfusion index has guiding value for clinical prediction of cesarean section maternal hypotension. The prediction model established by BMI, umbilical cord around neck, anesthesia method, and perfusion index has guiding value for clinical prediction of poor prognosis of neonates.

THE EFFECT OF ONDANSETRON ADMINISTRATION 20 MINUTES PRIOR TO SPINALANAESTHESIA ON HAEMODYNAMIC STATUS IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION: COMPARISON BETWEEN TWO DIFFERENT DOSES

Background: Risks involved in general anaesthesia has made spinal anaesthesia the standard anaesthetic technique for caesarean section. Spinal anaesthesia has its own side effects that may affect the mother and the unborn child's wellbeing. Ondansetron is a 5-HTreceptors antagonist, basically used as an antiemetic drug and is thought to counteract bradycardia and hypotension induced by spinal block. The primary aim of the study was to assess systolic blood pressure (SBP), diastolic blood pressure (DBP), and the mean arterial pressure (MAP) among different ondansetron doses and a control group in different time intervals. Methods:Aprospective, double-blinded, placebo- controlled, randomized clinical trial was conducted during a period of 6 months on a total of 90 patients, scheduled to undergo elective caesarean delivery under spinal anesthesia, in SMGS Hospital, Jammu. All patients with ASAI and II parturient, who were included in the study. Results: Number of patients with hypotension, was not signicantly different between the study groups. Total number of hypotensive episodes showed signicant difference and was lower in Group 2. (p=0.044) Patients of group 1 had increased frequency of administration of mephtermine in response to fall in blood pressure.In Ondansetron group, there was a dose dependant decrease in ephedrine requirement. Conclusion: Administering ondansetron (6 mg) 20 minutes before spinal block can raise the hope of increasing the efcacy of Spinal anesthesia. It may not cause reduction in the incidence of hypotension in caesarean section under spinal block, but can signicantly decrease the consumption of adrenergic agonists.

Pleth variability index measured in the sitting position before anesthesia can predict spinal anesthesia-induced hypotension in cesarean section: An observational study

Background: Hypotension induced by spinal anaesthesia during caesarean section can have devastating effects on the parturient and foetus. This study investigated the ability to predict spinal anaesthesia-induced hypotension via the perfusion index and pleth variability index in the sitting position caesarean section. Materials and Methods: We enrolled 46 patients undergoing elective caesarean section in this study and used standard anaesthetic management in all patients. The haemodynamic parameters, perfusion index and pleth variability index of the patients were recorded at specific time points. Results: Hypotension occurred in 61.4% of the patients. There was a difference in the pleth variability index values between patients with and without hypotension at baseline as well as in the sitting position and after spinal anaesthesia (P = 0.023, 0.001, and 0.040, respectively). According to the receiver operating characteristic curve analysis, the pleth variability index value of the patients in the sitting position was a predictor of spinal anaesthesia-induced hypotension (area under the curve = 0.780, 95% confidence interval [CI]: 0.633–0.927, P = 0.001). The cut-off value of the pleth variability index (in the sitting position) for predicting hypotension was 20.5% (sensitivity: 76.5%, specificity: 70.4%). Multivariate logistic regression analysis revealed that an increased pleth variability index in the sitting position before spinal anaesthesia was an independent risk factor of spinal anaesthesia-induced hypotension (odds ratio: 0.78, 95% CI: 0.62–0.98, P = 0.034). Conclusion: The pleth variability index in the sitting position before spinal anaesthesia is a useful tool for predicting spinal anaesthesia-induced hypotension during caesarean section.

A Study of Phenylephrine Administration for the Prevention and Treatment of Hypotension in Cesarean Section during Spinal Anaesthesia

Background: Hypotension remains the most common complication following spinal anesthesia in cesarean sections. Despite using various preventive measures, hypotension occurs in most cases; vasopressors are often required. The current study evaluated the safety and efficacy of prophylactic phenylephrine infusion in preventing spinal anesthesia-induced hypotension in the Cesarean Section. Materials and Methods: A total of 50 parturients aged 20-35 years with American Society of Anesthesiologists (ASA) grade II, scheduled for elective cesarean sections were randomly allocated into one of the two groups. Group A (n=25) received intravenous prophylactic phenylephrine infusion at 100μg/min for 3min after spinal anesthesia using a syringe pump. Each minute, systolic arterial pressure (SAP) was measured, and infusion stopped if SAP > baseline and continued if less than or equal to baseline systolic arterial pressure. Intravenous phenylephrine bolus 100μg was given when SAP decreased to <80% of baseline. Group B (n=25) received only intravenous phenylephrine bolus 100μg when SAP decreased to <80% of baseline. After 1 minute of spinal anesthesia, Heart Rate (HR), SAP, and diastolic blood pressure (DBP) were recorded every minute until the baby's extraction. After the delivery of the baby, APGAR scores at 1 minute and 5 minutes were noted. Umbilical artery blood was sent for analysis of the pH. The total volumes of study solutions given up to the time of delivery of the baby were recorded. Results: Phenylephrine infusion decreased the incidence and frequency of hypotension compared with control and the phenylephrine dose was much higher in the infusion group than in the control group (p=0.0001). None of the patients had any incidence of nausea or vomiting. There was no significant difference in umbilical artery blood pH and no reduction in the APGAR scores. HR was significantly slower in the infusion group compared with the control group. Conclusion: A prophylactic infusion of phenylephrine100 μg/min in patients receiving spinal anesthesia for elective cesarean delivery decreased the incidence of hypotension and without any deleterious neonatal outcome.