Spinal Hypotension Research Articles

Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section.

Background and aim: Spinal anesthesia is the most common type of anesthesia administered for caesarean section and it is frequently associated with hypotension. When post-spinal hypotension is accompanied with bradycardia, the condition may become more complicated. Numerous pharmacological agents have therefore been tried for prevention of hypotension and 5HT3 antagonists are the latest in the armamentarium. However, studies have shown conflicting evidence regardings the effectiveness of 5HT3 inhibitors (ondansetron and granisetron) in preventing spinal hypotension. We have tried to address this controversy and also wanted to explore the adverse effects of granisetron on the foetus, if any.Materials and methods: Two hundred patients were included in the study and divided into two groups of 100 patients each. Group S patients received 5ml of 0.9% normal saline while Group G patients received IV granisetron 1mg (diluted to 5ml) 10 minutes prior to administration of spinal anesthesia. Analysis of variance (ANOVA) test was used for comparing the data, Student t-test was applied to compare the difference between the two means and Chi-Square test was used to test significance of difference of proportions.Results: The incidence of hypotension in Group S was 69%, whereas it was 37% in Group G (p<0.001), hence patients of Group S required a significantly higher (p=0.001) amount of mephentermine. Haemodynamic parameters were well maintained throughout the study period in patients of Group G. The neonatal outcome was assessed by Apgar score at 0 minutes, one minute, and five minutes after delivery, and it was comparable between the two study groups.Conclusion: Intravenous granisetron 1mg if administered before administering spinal anesthesia can effectively attenuate hypotension in parturients without any adverse effects on the mother and the neonate.

Norepinephrine versus Ephedrine in Prevention of Hypotension after Spinal Anesthesia

Background: There is increasing attitude to use norepinephrine for prevention of spinal hypotension. Though, data is not adequate for routine use in clinical practice. Aim of the study was to compare the effectiveness and safety of norepinephrine infusion versus ephedrine infusion for prevention of spinal hypotension. The primary outcome was maintaining systolic blood pressure changes within 20% of baseline. Methods: In our prospec‌tive double blinded randomized study, we studied 130 patients, underwent elective surgeries under spinal anesthesia. Patients were randomly divided into two equal groups: Ephedrine group; received ephedrine (5mg/ml), and Norepinephrine group; received norepinephrine (5µg/ml). After spinal anesthesia, the study drug was started at a rate 30ml/h and adjusted according to blood pressure. Hypotension was treated by 1 ml bolus of the study drug. We assessed; systolic blood pressure, pulse, total volume of infusion, need for boluses, and complications. Results: Systolic blood pressure decreased in both groups in comparison to baseline at 2, 4, 6, and 8 minutes. When comparing both groups; blood pressure was lower in ephedrine group after 2 and 4 minutes, after that both groups were comparable. There was increase in heart rate in the 1st 10 minutes in ephedrine group. Attacks of tachycardia and hypertension occurred more in ephedrine group, but no differences regarding volume of infusion, need for boluses, attacks of bradycardia or hypotension. Conclusion: both drugs are effective in prevention of spinal hypotension, but norepinephrine has faster onset with fewer episodes of tachycardia and hypertension leading to better hemodynamic stability.

Fluid loading therapy to prevent spinal hypotension in women undergoing elective caesarean section: Network meta-analysis, trial sequential analysis and meta-regression.

BACKGROUNDFluid loading is one of the recognised measures to prevent hypotension due to spinal anaesthesia in women scheduled for a caesarean section.OBJECTIVEWe aimed to evaluate the current evidence on fluid loading in the prevention of spinal anaesthesia-induced hypotension.DESIGNSystematic review and network meta-analysis with trial sequential analysis and meta-regression.DATA SOURCESMedline, Epub, Embase.com (Embase and Medline), Cochrane Central, Web of Science and Google Scholar were used.ELIGIBILITY CRITERIAOnly randomised controlled trials were used. Patients included women undergoing elective caesarean section who received either crystalloid or colloid fluid therapy as a preload or coload. The comparator was a combination of either a different fluid or time of infusion.RESULTSA total of 49 studies (4317 patients) were included. Network meta-analysis concluded that colloid coload and preload offered the highest chance of success (97 and 67%, respectively). Conventional meta-analysis showed that crystalloid preload is associated with a significantly higher incidence of maternal hypotension than colloid preload: risk ratio 1.48 (95% CI 1.29 to 1.69, P < 0.0001, I2 = 60%). However, this result was not supported by Trial Sequential Analysis. There was a significant dose–response effect for crystalloid volume preload (regression coefficient = −0.073), which was not present in the analysis of only double-blind studies. There was no dose–response effect for the other fluid regimes.CONCLUSIONUnlike previous meta-analysies, we found a lack of data obviating an evidence-based recommendation. In most studies, vasopressors were not given prophylactically as is recommended. Studies on the best fluid regimen in combination with prophylactic vasopressors are needed. Due to official european usage restrictions on the most studied colloid (HES), we recommend crystalloid coload as the most appropriate fluid regimen.TRIAL REGISTRATIONCRD42018099347.

O efeito de epinefrina, norepinefrina e fenilefrina no tratamento da hipotensão pós‐raquianestesia: estudo clínico comparativo

Background and objectivesLimited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal‐hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal‐hypotension and ephedrine requirement during cesarean delivery. MethodsOne hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 μg.mL‐1 (n=40), epinephrine 5 μg.mL‐1 (n=40), phenylephrine 100 μg.mL‐1 (n=40) or 0.9% saline infusions (n=40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of iv ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. ResultsThere was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p <0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p=0.001). ConclusionThere is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered as an alternative agent for management of spinal hypotension.

Evaluation of Leg Wrapping with Elastic Bandage for the Prevention of Post Spinal Hypotension in Cesarean Section

Evaluation of Leg Wrapping with Elastic Bandage for the Prevention of Post Spinal Hypotension in Cesarean Section

The effect of epinephrine for the treatment of spinal-hypotension: comparison with norepinephrine and phenylephrine, clinical trial

Background and objectivesLimited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal-hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal-hypotension and ephedrine requirement during cesarean delivery. MethodsOne hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 μg.mL−1 (n = 40), epinephrine 5 μg.mL−1 (n = 40), phenylephrine 100 μg.mL−1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of intravenous ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. ResultsThere was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p < 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p = 0.001). ConclusionThere is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered an alternative agent for management of spinal hypotension.

The effect of spinal hypotension and anesthesia-to-delivery time interval on neonatal outcomes in planned cesarean delivery

Maternal hypotension after spinal anesthesia, and time from anesthesia to delivery, are potentially modifiable risk factors for neonatal acidosis. This study aimed to examine the relationship between the time from spinal anesthesia to delivery and spinal hypotension in planned cesarean deliveries and their effect on neonatal outcome, primarily neonatal acidosis. We performed a retrospective analysis of women with singleton pregnancy undergoing spinal anesthesia for planned cesarean delivery between 37 0/7 and 41 6/7 weeks' gestation using electronic medical records. The occurrence of spinal hypotension and anesthesia-to-incision and incision-to-delivery intervals (minutes) were the primarily studied variables. In addition, spinal hypotension index was developed to account for the duration and magnitude of maternal hypotension. The 90th percentile for the spinal hypotension index defined the sustained spinal hypotension group. The primary outcome was neonatal acidosis (pH of ≤7.1 or base deficit of ≥12.0). The odds ratios were calculated using univariate and multivariate logistic regression models. The multivariate analysis included sporadic spinal hypotension or sustained spinal hypotension, use of vasopressor treatment, and anesthesia-to-incision and incision-to-delivery intervals. We included 3150 women in the study. Notably, 43.4% experienced at least 1 event of spinal hypotension (sporadic) and 14.8% experienced sustained spinal hypotension. Neonatal acidosis occurred in 3.4% cases of sporadic spinal hypotension (odds ratio, 1.83; 95% confidence interval, 2.27-2.87) and in 5.8% cases of sustained hypotension (odds ratio, 3.00; 95% confidence interval, 1.87-4.80). Both anesthesia-to-incision and incision-to-delivery intervals were significantly associated with neonatal acidosis as follows: at 90th percentile cutoff, the odds ratios for neonatal acidosis were 3.82 (95% confidence interval, 2.03-7.19) and 2.94 (95% confidence interval, 1.70-5.10), respectively. The use of ephedrine (odds ratio, 2.42; 95% confidence interval, 1.35-4.32) but not phenylephrine (odds ratio, 0.76; 95% confidence interval, 0.34-1.72) treatment was also associated with more cases of neonatal acidosis. The woman's age, gestational age, neonatal birthweight, fetal presentation, and the number of previous cesarean deliveries were not associated with neonatal acidosis. In multivariate analysis, anesthesia-to-incision and incision-to-delivery intervals, use of vasopressor treatment, and sustained spinal hypotension were independently associated with neonatal acidosis. After adjustment, the risk for neonatal acidosis did not increase in women who experienced sporadic spinal hypotension only. Neither neonatal acidosis nor the primary research variables were associated with neonatal complications such as transient tachypnea of the newborn, respiratory distress, or admission to the neonatal unit. Neonatal acidosis in planned cesarean delivery was common. However, serious perinatal consequences were rare. The adverse effects of sustained spinal hypotension and prolonged anesthesia-to-incision and incision-to-delivery intervals on neonatal acid-base balance were additive. This supports the adoption of prevention strategies for spinal hypotension, which is widely evidenced based on the obstetrical anesthesia literature, but still not universally used. Whether the reduction in intraoperative time intervals would benefit the neonate should be determined by future prospective studies.

Frequency of spinal hypotension in patients undergoing elective lower segment caesarean section using preoperative preload and intramuscular ephedrine.

Objectives: To observe the frequency of spinal hypotension in patients undergoing Elective Lower Segment Caesarean Section receiving pre-operative preload compared with intramuscular ephedrine. Study Design: Cross Sectional study. Setting: Department of Anesthesia, Independent Medical College, Faisalabad. Period: July 1st 2018 to December 31st 2018. Material &amp; Methods: This study included fifty-two female patients, aged 20-35 years, undergoing elective C/section under spinal anesthesia with ASA physical status I &amp; II, pre-operatively preloaded and given prophylactic intramuscular ephedrine. Hemodynamic changes were recorded in both groups after receiving spinal anesthesia. Results: Compared with the prophylactic ephedrine group, frequency of Post spinal hypotension was higher significantly in pre-load group (p=0.019). Conclusion: It has been concluded that there is the use of prophylactic intra muscular ephedrine is associated with low incidence of post spinal hypotension.

Preeclampsia and the anaesthesiologist: current management.

Preeclampsia remains an important cause of maternal and neonatal morbidity and mortality. Recent interest in angiogenic biomarkers as a prognostic indicator is reviewed, together with analgesic, anaesthetic and critical-care management of the preeclamptic patient. There has been recent interest in the angiogenic biomarkers placental growth factor and soluble fms-like tyrosine kinase-1 in establishing the diagnosis of preeclampsia and guiding its management. Neuraxial blocks are recommended for both labour and operative delivery if not contraindicated by thrombocytopenia or coagulopathy, although a safe lower limit for platelet numbers has not been established. For spinal hypotension phenylephrine is noninferior to ephedrine in preeclamptic parturients and may offer some benefits. When general anaesthesia is required, efforts must be made to blunt the hypertensive response to laryngoscopy and intubation. Transthoracic echocardiography has emerged as useful technique to monitor maternal haemodynamics in preeclampsia. Improvements in the diagnosis of preeclampsia may lead to better outcomes for mothers and babies. Peripartum care requires a multidisciplinary team approach with many preeclamptic women receiving neuraxial analgesia or anaesthesia. Women with severe preeclampsia may require critical-care support and this should meet the same standards afforded to other acutely unwell patients.

Prophylactic norepinephrine infusion or leg wrapping for postspinal hypotension in elective caesarean delivery: A randomised, double-blind, placebo-controlled trial.

Because of its alpha and beta agonist properties, norepinephrine infusion is currently being studied for the prevention of spinal hypotension during caesarean delivery. Vasopressor infusions are not always possible if there is an unavailability of infusion pumps. Leg wrapping with crepe bandage is an effective technique for prevention of postspinal hypotension and could be useful in resource-poor settings. The aim of this study was to compare the incidence of hypotension with norepinephrine infusion or leg wrapping with a control group in women undergoing caesarean delivery with spinal anaesthesia. Randomised, double-blind, controlled trial. Single centre, tertiary level institute, India.Study period 3 April 2018 to 31 March 2019. One hundred and forty-four women aged 19 to 40 years with a singleton pregnancy. In group Leg Wrapping, crepe bandage was applied tightly from metatarsus to groin. Group Norepinephrine and the control group received sham leg wrapping. In group Norepinephrine, the women received a norepinephrine infusion according to their body weight, while group Leg Wrapping and the control group received a 0.9% normal saline infusion at a similar rate. All three groups received a 500 ml co-load of Ringer's solution over 15 min. Noninvasive SBP was monitored every 2 min until delivery, and every 5 min thereafter. Any hypotensive event (SBP < 20% of baseline) was treated with an intravenous bolus of norepinephrine (7.5 μg). The primary outcome was the incidence of hypotension. The secondary outcomes were performance error measurements, and the incidences of hypertension, bradycardia, norepinephrine rescue bolus and neonatal outcomes. The incidences of hypotension were significantly lower in the norepinephrine infusion group and the leg wrapping groups than the control group (P values 0.021 for both). Performance error calculations showed that SBP was maintained closer to baseline with the norepinephrine infusion. Norepinephrine infusion and leg wrapping can both reduce the incidence of postspinal hypotension during elective caesarean delivery compared with saline infusion alone. Clinical trial number and registry URL: CTRI/2018/04/012917 registered at Clinical Trial Registry of India http://www.ctri.nic.in/Clinicaltrials/login.php.

Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

BackgroundSpinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia.MethodA prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and non-preeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count < 80 × 109/L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values < 0.05 were considered statistically significant.ResultThe incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics.ConclusionThe incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.

Management of obstetric spinal hypotension in resource-limited areas

Hypotension following obstetric spinal anesthesia is a common problem and has remained a focus of research and controversy for many decades. Recent advances on this subject have resulted in numerous recommendations for management of obstetric spinal hypotension. However, these advances have failed to reduce the unacceptable number of fatalities that occur in resources limited environments which constitutes more than 75% of the world’s population. The reason being the failure of translation of the research done in resource-rich environments, and its application and performance in resource-poor environments. This review focuses on the problems faced by clinical environment that are deficient in appropriate resources and manpower. It further proposes an outline for management of spinal hypotension and recommends suitable research agenda to address the deficiencies.&#x0D; Received: 5 Sep 2018Reviewed: 7 Nov 2018Accepted: 10 Nov 2018&#x0D; Citation: Ismail S. Management of obstetric spinal hypotension in resource-limited areas. Anaesth Pain &amp; Intensive Care 2018;22 Suppl 1:S133-S136

Prophylactic co-administration of two different bolus doses of norepinephrine in spinal-induced hypotension during caesarean section: A prospective randomized double-blinded study

Background: Vasopressors for prophylaxis and treatment of spinal hypotension have grown in popularity in recent years. Norepinephrine is now emerging as one of the feasible options for prevention as well as management of spinal-induced hypotension in caesarean section (CS). The aim of our study was to compare the efficacy of two different doses of norepinephrine as prophylaxis for spinal-induced hypotension during CS. Material and Methods: Total 110 patients were recruited in this prospective randomized double-blind study from December 2017 to June 2019. After fulfilling the inclusion and exclusion criteria, this study was conducted on 90 patients undergoing elective CS under spinal anesthesia, who were assigned into three groups of 30 patients each. Group N6received norepinephrine 6 μg as an intravenous bolus, group N4received norepinephrine 4 μg, and group C received normal saline simultaneously with subarachnoid block. Incidence of hypotension, requirement of rescue doses of norepinephrine, time of first rescue dose, hemodynamic parameters, adverse effects, and neonatal complications were assessed, compared and analyzed. Results: The incidence of post spinal hypotension was 63.33% in group N6, 80% in group N4, and 83.33% in group C (p = 0.155). Total rescue dose requirement of norepinephrine was significantly less in group N6(8.21 ± 2.97 μg) as compared to N4(9.00 ± 3.06 μg) and control group (11.00 ± 4.57 μg).(p = 0.011). The median time to first rescue dose requirement of norepinephrine was significantly delayed in group N6(6[8–4.5] min) and group N4(4[9–2.5] min) as compared to control group (4[5–2] min) (p = 0.004). Conclusion: Prophylactic intravenous bolus dose of 6 μg norepinephrine when co-administered with spinal anesthesia was found to be more effective than 4 μg norepinephrine in terms of decreasing total rescue dose requirement of vasopressor and delaying the time to first rescue dose, without significant change in the incidence of hypotension.

Elective Cesarean Section in Obstetric COVID-19 Patients under Spinal Anesthesia: A Prospective Study.

Background:Managing obstetric emergencies in COVID-19 pandemic is a real challenge as these patients need timely intervention to save the life of the mother and the baby. Hence, to avoid life-threatening challenges, all pregnant patients were electively admitted and tested for COVID-19 near term to anticipate the difficulties and prevent complications.Aim:Our aim was to assess the impact of COVID-19 infection on maternal morbidity and mortality as well as the effect on the neonate under spinal anesthesia.Settings and Design:This was a prospective observational study.Materials and Methods:One hundred and fifteen COVID-19-positive pregnant patients in the age group of 20–40 years from July 2020 to December 2020 were electively taken for cesarean section under spinal anesthesia. Patients who needed emergency cesarean delivery were excluded from the study. Emergency cesarean delivery was avoided to reduce the risk of aerosol generation under general anesthesia as endotracheal intubation of COVID-19 patients poses a significant risk of viral exposure to doctors and staff. Written informed consent was obtained from all patients. Spinal anesthesia was given at L4–L5 intervertebral space. Demographic parameters, anesthetic and surgical parameters, and neonatal parameters were observed. Any inadvertent event was noted.Statistical Analysis:Data were expressed as mean, median, percentage, or number.Results:All pregnancies were singleton. None of the patients was converted to general anesthesia. One hundred and ten were either mildly symptomatic or asymptomatic. Five of our patients had severe symptoms and needed intensive care unit care preoperatively and postoperatively. Seven patients developed spinal hypotension and were managed by vasopressors. No significant thrombocytopenia was noted in any of our patients. None of our patients developed symptomatic thromboembolism. Vertical transmission was not reported in any of the cases. All babies were born with weight >2500 g and good APGAR score.Conclusion:Spinal anesthesia for LSCS is safe and effective for obstetric anesthesia in COVID-19 both for the parturient and the newborn.

Perfusion index as an early predictor of hypotension following spinal anesthesia for cesarean section

Introduction: Hypotension is a common complication after spinal anesthesia for cesarean delivery which is caused by sympathetic block 1. This can result in adverse maternal and fetal outcomes. Hence prevention and early treatment of spinal hypotension early has been a key research area in obstetric anesthesia. Intermittent non-invasive blood pressure measurement is the standard practice that fails to detect episodes of hypotension in a timely fashion. Methods: Noninvasive PI and blood pressure were measured in 109 healthy parturients undergoing elective cesarean section under spinal anesthesia. Results: PI appeared to increase significantly and more quickly in parturients with significant hypotension. Discussion: Findings may be due to the thoracic sympathetic blockade. Conclusion: Perfusion index can be a useful tool to early predict hypotension following spinal anesthesia for cesarean section. Response to ephedrine can be quickly assessed by the change in the PI which helps to decide on further boluses of ephedrine. Effect on the vascular tone by oxytocin is significant with 5IU bolus, though it does not cause a significant blood pressure drop.

Magnitude and Associated Factors of Post Spinal Hypotension Among Pregnant Mothers Who Delivered by Elective Caesarean Section at Gandhi Memorial Hospital, Addis Ababa, Ethiopia

Introduction: Hypotension is a 20% to 30% reduction in baseline blood pressure. Infrequently, hypotension after spinal anesthesia can be significantly severe in pregnant mother and increases intraoperative and postoperative morbidity and mortality. Objectives: To assess magnitude and associated factors of post spinal hypotension among pregnant mothers who delivered by elective cesarean sections from January to February 2016 at Gandhi Memorial Hospital, Addis Ababa. Methods: Institution based cross sectional study design was conducted. All lists of pregnant mothers who gave birth by elective cesarean section under spinal anesthesia at Gandhi Memorial Hospital were included. Training was given for data collectors and supervisors. Regular supervision and follow up were made. Data was entered in to Epi info version 7 software and transported to SPSS version 20 for analysis. Odd ratio and 95% confidence interval was computed. Bivariate and Multivariate analysis used to identify factors associated with hypotension. Results: The study was conducted on 60 study participants. 24 (40%) were equally found between 25-29 years and 30-34 years. The incidence of hypotension was 80% during five to fifteen minute and 83% during fifteen to twenty five minute. 70% of the study participants were preloaded with more than 500ml of crystalloid and 60% were took oxytocin for uterine contraction. Majority of them were in supine position prior to spinal anesthesia. Conclusion and recommendation: The magnitude of post spinal hypotension was so high that the use vigorous fluid resuscitation and the use of prophylactic vasopressor were recommended.

Comparative study of preloading and Co-loading with ringer lactate for prevention of spinal hypotension in elective cesarean section

Background: Prevention of spinal induced hypotension was remained challenge to anaesthesiologist for years as it poses risk to mother as well as baby. Prehydration with various volumes of crystalloid or colloids was attempted in the past variable success rate. Recently the principle of preloading with fluids has been challenged by various studies. This prompted us to evaluate the effectiveness of crystalloid preloading compared to preloading for prevention of spinal hypotension. We evaluated vasopressor requirement and neonatal Outcome in the form of APGAR score as well. Material and method: ASA grade I parturients posted for elective cesarean section were randomly allocated in two study groups of 30 each to receive either preload or co-load with Ringers lactate solution. Blood pressure, heart rate, SpO2, vasopressor requirement and other outcomes recorded at regular interval. Results: Hypotension was observed significantly less in co-loading group (36%) than preloading group (60%). Mean vasopressor requirement was also significantly more in preload group. Heart rate change, nausea, vomiting and fetal outcome remained same across both the groups. Conclusion: Co-loading with crystalloids is more effective strategy than preloading in prevention of spinal induced hypotension. We can save valuable time given for preloading in case of emergency cesarean sections.

Prophylactic phenylephrine and fluid co-administration to reduce spinal hypotension during elective caesarean section in a resource-limited setting: a prospective alternating intervention study.

Spinal hypotension is a common and clinically important problem during caesarean section. Current consensus recommendations for resource-rich settings suggest the use of a titrated phenylephrine infusion, in combination with fluid coloading, for prevention of maternal hypotension. In resource-limited settings, where syringe drivers are unavailable, these recommendations advise the addition of 500μg phenylephrine to the first 1l of intravenous fluid given after initiation of spinal anaesthesia, with additional vasopressor boluses as required. This prospective, alternating intervention study compared the use of a conventional phenylephrine rescue bolus strategy for prevention of hypotension, defined as systolic arterial pressure <90mmHg, with a phenylephrine infusion given according to the consensus recommendation. We studied 300 women having elective caesarean section. There were 77 (51%) women who developed hypotension in the bolus group vs. 55 (37%) in the phenylephrine infusion group (p=0.011). This represented a 29% reduction in hypotension, with a number needed to treat of 6.8. The six highest systolic arterial pressure readings occurred in the phenylephrine infusion group (range 166-188mmHg), and there were four instances of bradycardia (heart rate <50 beats.min-1 ) with preserved systolic arterial pressure in each group. There were no adverse clinical sequelae, and no differences in neonatal Apgar scores in either group. The consensus recommendation for phenylephrine and fluid co-administration in resource-limited settings appears effective in preventing maternal hypotension, but at the cost of sporadic systolic hypertension.

Risk Factors and Complications of Patients Undergoing Anesthesia

Background: The incidence of perioperative complications and mortality related to anesthesia increased and involved multiple factors so, The aim of the present study is to assess of predisposing risk factors and complications for patients during anesthesia. Descriptive research design was used to conduct this study. Sitting: The study was conducted in the operating room for emergency care units at Assuit university Hospital. Sample: One hundred adult male and female patients admitted to mentioned settings and complain of risks or complications from anesthesia. Tools: Tool one: demo geographic data and general physical and medical data, Tool two: risk factors sheet, Tool three Assessment sheet of complications during anesthesia. Results: the most common risk factors of anesthesia were hypothermia 43%, hypotension 79%. Common complication were hypothermia in general anesthesia78%, and hypotension in spinal anesthesia 65%. Conclusion: a highly statistically significant relation was found regarding to risk factors as upper respiratory tract infections, renal impairment and the obesity, and the main complication was hypothermia. Recommendations: provide health teaching for patients before surgery and good preoperative preparation.

A Prospective Observational Study of the Change in Regional Cerebral Oxygen Saturation During Cesarean Delivery in Women Receiving Phenylephrine Prophylaxis for Spinal Hypotension

(Int J Obstet Anesth. 2019;37:29–35) During cesarean delivery (CD) performed under spinal anesthesia, the incidence of hypotension has been reported to be as high as 70% to 80%. Previous studies have shown that this spinal-induced hypotension leads to decreased regional cerebral oxygen saturation (ScO2), and treatment with ephedrine has returned ScO2 to baseline levels. In current practice, though, a prophylactic phenylephrine infusion is frequently used to prevent spinal hypotension during CD. There has been limited research on the effect of phenylephrine on ScO2. This prospective, observational cohort study was performed to investigate the change in ScO2 using near infrared spectroscopy in women receiving a prophylactic phenylephrine infusion during CD under spinal anesthesia.