Spinal-induced Hypotension Research Articles

Preventing Spinal-induced Hypotension During Elective Cesarean Sections

PurposeThe purpose of this quality improvement project was to implement an evidence-based intraoperative protocol to reduce the incidence of spinal-induced hypotension during elective cesarean sections. DesignA quality improvement project. MethodsAfter receiving education, anesthesia providers implemented the intraoperative protocol for 6 weeks on elective cesarean sections. Intraoperative anesthesia records were retrospectively reviewed and evaluated preimplementation and postimplementation to determine the impact of the project on the incidence of spinal-induced hypotension. FindingsThe final sample included 134 patient charts (64 preimplementation and 72 postimplementation). The incidence of hypotension 10 minutes after spinal placement was not significantly different before (n = 9) or after implementation (n = 13; χ2 = 0.4, P = .554). After project implementation, the rate of hypotension was 22% (n = 13) in patients not treated per the protocol and 0% (n = 0, χ2 = 3.5, P = .062) in patients treated per the protocol. There was a 39.4% (P < .001) reduction in the need for rescue doses of phenylephrine and a 27.8% (P = .001) reduction in the need for rescue doses of ephedrine after protocol implementation. ConclusionsHypotension was not significantly decreased for all patients after project implementation but was eliminated for patients in whom the protocol was used. Provider utilization of the intraoperative protocol was only 18%. It is recommended to pursue additional interventions to increase protocol utilization, accessibility of protocol components, and staff training. Future studies can investigate the impact of this protocol on maternal nausea and vomiting incidence during elective cesarean sections.

Association between plain ropivacaine dose and spinal hypotension for cesarean delivery: a retrospective study.

Data on the association between the plain ropivacaine dose and maternal hypotension during cesarean delivery are limited. Thus, this study aimed to explore this association. This retrospective study included patients undergoing cesarean sections under spinal or combined spinal-epidural anesthesia with plain ropivacaine at The First Hospital of Fuyang, Hangzhou, China, between 2018 and 2022. Data were obtained from the anesthesia information management system. Liner trend tests were used to distinguish the linear relationship between spinal hypotension and the plain ropivacaine dose, and receiver operating characteristic curves were used to calculate the dose threshold. Logistic regression was used to adjust for confounders. Sensitivity analyses were performed to evaluate the stability of the results. The secondary outcome was vasopressor use (metaraminol and ephedrine). In total, 1,219 women were included. The incidence of hypotension linearly correlated with the plain ropivacaine dose (adjusted P-value for trend, P<0.001). Thus, we used a dose threshold of 17.5 mg to compare the dose as a binary variable (≥17.5 mg vs. <17.5 mg). Plain ropivacaine doses of ≥17.5 mg were associated with a higher incidence of spinal hypotension (adjusted odds ratio: 2.71; 95% confidence interval [1.85-3.95]; P<0.001). The sensitivity analyses yielded similar results. The plain ropivacaine dose also correlated with metaraminol use but not ephedrine use. The incidence of spinal-induced hypotension in women undergoing cesarean section linearly correlated with the plain ropivacaine dose. The dose threshold for hypotension risk was 17.5 mg.

The Prediction And Prevention Of Spınal Anaesthesıa-Induced Hypotensıon With Perfusion İndex And The Effect Of Crystalloid

Hypotension is a dangerous and common problem for patients under spinal anesthesia. Spinal anesthesia-induced hypotension(SIH) is often arisen from heart rate decrease and venous blood pooling under the spinal block level because of sympathetic blockage. Prediction and prevention of hypotension will be beneficial for the patients' health under spinal blockage. For prediction, many parameters like perfusion index(PI) have been using. This study aims to research the correlation between the patients' hemodynamic parameters, perfusion indices before spinal block and SIH, and the effectiveness of crystalloid preload before spinal block to the usage of ephedrine. Records from 101 patients between 18-100 years age, who underwent surgery with spinal anesthesia were studied. We enroll patients demografical characteristics, ASA-score, sensory-blockage level, opereation period, the patients' position for spinal block, local anethesic form-dosage, blockage level, patients' hemodynamic and PI parameters in the surgery, hypotension time, efedrin first usage time and dosage from records. These results analyzed with t-test, Pearson-Chi-Square, Wilcoxon-signed-rank and Mann-Whitney-U test. SIH were seen in 25,7% of patients. The incidence of hypotension increases with age and block level. Any corelation between SIH and PI degrees before spinal block was not found, but MAP degrees before spinal block were significantly different in hypotension group. 10ml/kg cristaloid-preload was used 37,6% of patients. SIH was not prevented by cristaloid-preload and cristaloid-preload didn’t affect efedrine dosage-timing. Cristaloid-preload changed significantly patients heart rate and PI. In this study, we found that PI was not predictive factor for the development of SIH. Besides cristaloid-preload don’t avoid development of SIH.

Insights into obstetric anesthesia practices: a quantitative survey among physicians across Arab countries

BackgroundObstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries.MethodsA questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators.ResultsOut of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion.ConclusionThis survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.

Update on the Obstetric Anesthesia Practice in Flanders/Belgium: A 10-year follow-up survey and review

Background: With 75% of women receiving neuraxial anesthesia for labor and cesarean section (CS) in Flanders, Belgium, obstetric anesthesia is an essential part of perinatal care. Despite advancements in obstetric anesthesia and guidelines being updated regularly, past surveys have shown great variability among hospitals. Objective: This investigation aims to observe current obstetric anesthesia practices, compare them with previous surveys, and assess adherence to guidelines among anesthesiologists. Methods: An online questionnaire-based survey, approved by the KU Leuven Ethics Committee, was conducted focusing on three main topics: analgesia during labor, anesthesia for CS, and postoperative analgesia after CS. The survey, consisting of 127 questions, was distributed via email to the heads of anesthesia departments in 57 Flemish hospitals providing obstetric anesthesia care. Responses were anonymously analyzed. Results: For labor analgesia initiation, a conventional epidural with administration of ropivacaine 0.2% (+- sufentanil) remains the most widespread used technique, although Combined-Spinal Epidural (CSE) has gained significant popularity. Patient-controlled epidural analgesia (PCEA) in combination with continuous epidural infusion (CEI) is the preferred maintenance method, however programmed-intermittent bolus (PIEB) has found its way into standard practice. CSs are mostly done by performing CSE or single shot spinal, using hyperbaric bupivacaine 0.5% with sufentanil. Spinal-induced hypotension is treated with a combination of left lateral tilt, fluid administration and vasopressor administration, usually as a bolus. Post-CS pain is mainly treated by a combination of oral/ parenteral analgesics and neuraxial analgesia (PCEA +- CEI), with only a minority choosing regional techniques such as wound infiltration, transverse abdominal plane blocks, quadratus lumborum blocks, etc. Conclusion: Compared to previous surveys, the Flemish anesthesiologists adhere well to the latest guidelines and gold standards in obstetric anesthesia, consistently modernizing their practices. Nevertheless, with the continual introduction of novel techniques and methods, it is imperative for practitioners to maintain efforts in pursuing ongoing innovation.

Effect of esketamine on hypotension in women with preoperative anxiety undergoing elective cesarean section: a randomized, double-blind, controlled trial

To investigate the effect of low-doses esketamine on spinal anesthesia-induced hypotension in women with preoperative anxiety undergoing elective cesarean section, the randomized controlled trial enrolled 120 women aged 18–35 years who preoperative State-Trait Anxiety Inventory State scores > 40, conducted from September 2022 to August 2023 in Xuzhou Central Hospital, China. Women in the esketamine group received a single intravenous injection of 0.2 mg/kg esketamine after sensory block level achieved. The incidence of hypotension in the esketamine group was significantly lower than the control group at T2 (10% [6 of 60]; P < 0.001), T3 (5.0% [3 of 60]; P = 0.007) and T4(5.0% [3 of 60]; P = 0.004). Despite being higher in the esketamine group, the overall rates of hypertension (11.7% [7 of 60]; P = 0.186), tachycardia (23.3% [14 of 60]; P = 0.246), and bradycardia (0.0% [0 of 60]; P = 0.079) were no significantly difference between the two groups. STAI-S scores was significantly lower in the esketamine group (mean [SD] 37.52[7.14]) than in the control group (mean [SD] 41.03[9.66], P = 0.39) in postoperative day 1. Spinal anesthesia combined with intravenous low-doses esketamine infusion can significantly reduce the incidence of hypotension in women with preoperative anxiety undergoing elective cesarean section.

Effect of Ondansetron on Maternal Hypotension During Spinal Anesthesia With Ropivacaine for Cesarean Sections: A Randomized, Double-Blind Trial.

Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, has been proven to be effective in the prevention of spinal-induced hypotension for elective cesarean section. A total of 138primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Groups ONDA4 and ONDA8, respectively, received 4 and 8mgof ondansetron in 100 mL normal saline, before spinal anesthesia with 1.7 mL ropivacaine 0.75% and 15 mcg of fentanyl, whereas the CONTROL group received an equal volume of normal saline. Noninvasive blood pressure and heart rate were recorded upon arrival, before and after spinal injection, and thereafter every minute for a time period of 10 minutes along with total doses of phenylephrine (mcg) or ephedrine (mg). Time required for the spinal anesthesia to achieve a sensory and motor block at the T4 level andBromage 3 scale respectively, as well as to regress to the T7 level and a Bromage1 scale were noted. Maternal nausea/vomiting or shivering, umbilical artery pH, and neonatal Apgar score at 1 and 5 min were also recorded. There were no differences between groups in systolic, diastolic blood pressure, heart rate (p=0.355, p=0.550, p=0.474 respectively), doses of phenylephrine or ephedrine, (p=0.920, p=0.142 respectively), time for the block to reach T4 (p=0.889) and Bromage scale 3(p=0.269), or to regress to T7 (p=0.273) and Bromage scale 1 (p=0.392), the incidence of nausea/vomiting (p=0.898/p=0.365), umbilical artery pH (p=0.739), neonatal Apgar score at 1 and 5 min (p=0.936 and p=0.907 respectively). Our results showed no significant effect of two different doses of ondansetron, in preventing maternal hypotension, following spinal anesthesia with ropivacaine for cesarean section.

Comparative Study of Prophylactic Vs Conventional Phenylephrine Administration in Preventing Spinal Anaesthesia-Induced Hypotension in Elective caesarean Section Patients: A Quasi Experimental Trial

Objective: To determine the prophylactic effect of phenylephrine in patients undergoing spinal anaesthesia in comparison to the conventional group. Study design: Quasi experimental trial. Place and duration of study: HIT Hospital Taxila in the period of 6 months. Materials and methods: This quasi-experimental trial was conducted in HIT Hospital. Total 68 females were divided into two groups: Control group and Experimental group. Each group consisted of 34 patients aged between 20 to 40 years. The patients were scheduled for elective cesarean section deliveries under spinal anaesthesia. All patients of the experimental group were given prophylactic dose of phenylephrine 100mcg diluted in normal saline after undergoing spinal anaesthesia before the start of procedure. Control group patients were only given normal saline as a placebo after undergoing spinal anaesthesia before the start of procedure. Control group patients were given phenylephrine as conventional treatment only if they experienced hypotension during the procedure. Results: Among the patients in the experimental group none experienced hypotension. Their blood pressure remained fairly constant in the normal range. In the control group, 4 out of 34 patients (11.7%) had their blood pressure dropped below the cutoff point of 90/60 mmHg. Conclusions: Our results show that a prophylactic dosage regimen i.e., 100mcg of phenylephrine is effective in controlling spinal -anaesthesia -induced hypotension in patients undergoing Caesarean-section. In comparison with conventional group where hypotension occurs only in few patients.

Internal Jugular Vein Collapsibility Index versus Inferior Vena Cava Collapsibility Index Guided Preloading for Prevention of Spinal Anesthesia Induced Hypotension During LSCS: An Interventional Study

Background and Aims: Goal directed fluid therapy (GDFT) in parturients helps to prevent spinal anesthesia induced hypotension (SAIH) and volume overload. This interventional study compared the inferior vena cava collapsibility index (IVCCI) and the internal jugular vein collapsibility index (IJVCI) guided preloading for prevention of SAIH during lower segment ceserean section (LSCS) in terms of the incidence of SAIH as the primary outcome and the total amount of fluid, mean dose of the vasopressor, the number of boluses of vasopressor required, and the incidence of intra-operative complications as secondary outcomes. Methodology: A total of 144 full-term parturients aged 20–40 years with American society of anaesthesiologists (ASA) grade II, height (140–165 cms), weight (40–70 kgs), those who were fluid responders, and those who had a window period of 1 hour before surgery under spinal anesthesia (SA) undergoing LSCS were allocated into two groups (n = 72): group IJV and group IVC. Ultrasonography (USG) guided Internal jugular vein (IJV) and Inferior vena cava (IVC) collapsibility index (CI) was recorded an hour before spinal anesthesia (SA) as per the groups assigned and preloaded accordingly. After SA, the incidence of SAIH, the requirement of vasopressor, and fluid were recorded, and side effects were managed. Results: In group IVC, the incidence of SAIH (36.84%), mean dose (3.51 ± 5.02 µg), and mean boluses (0.44 ± 0.63) of norepinephrine required to manage hypotension were significantly lower than in group IJV, and the mean goal directed fluid administered before LSCS (504.46 ± 181.48 ml) and overall mean total fluid (1104.39 ± 160.99 ml) administered were significantly higher than in group IJV. Except for shivering, the incidence of all other complications was significantly lower in group IVC (p &lt; 0.05). Conclusion: Both IVCCI and IJVCI guided preloading are effective in combating SAIH during LSCS, but IVCCI is comparatively better than IJVCI for CI guided preloading.

Prediction of spinal anesthesia-induced hypotension in cesarian section with focus on carotid doppler ultrasound and cardiometry

Prediction of spinal anesthesia-induced hypotension in cesarian section with focus on carotid doppler ultrasound and cardiometry

Comparative Efficacy of Intermittent Bolus Doses of Phenylephrine and Norepinephrine in Preventing Maternal Bradycardia during Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Background and Aims: Maternal hypotension is a common concern during cesarean sections (CS) with spinal anesthesia and can have adverse consequences for both the mother and fetus. This study aimed to investigate the prophylactic effectiveness of intermittent boluses of phenylephrine and norepinephrine in preventing maternal bradycardia during maintenance of systolic blood pressure (SBP) within 90–100% of baseline. Material and Methods: Two hundred American Society of Anesthesiologists physical status -II parturients scheduled for CS with subarachnoid block (SAB) were randomly assigned to Group A (phenylephrine, 50 µg) or Group B (norepinephrine, 4 µg). The primary goal was to assess the incidence of maternal bradycardia (≤50 bpm) whilst SBP maintenance at 90-100% of baseline. The secondary objectives encompassed total boluses administered, episodes of hypertension (≥120% of baseline), Intraoperative nausea and vomiting (IONV), and neonatal APGAR scores. The time from intrathecal injection to fetal delivery (induction–delivery interval) was also evaluated. Results: Both norepinephrine and phenylephrine groups effectively prevented spinal-induced hypotension, with similar outcomes However, Group A (phenylephrine) experienced a significantly higher incidence of bradycardia (18%) compared to Group B (norepinephrine) with only 5% (P=0.016). Episodes of hypertension, IONV, and neonatal APGAR scores were comparable between the two groups. Conclusion: Intermittent boluses of norepinephrine and phenylephrine demonstrated equivalent efficacy in preventing spinal-induced hypotension during CS. However, norepinephrine exhibited an advantage over phenylephrine by significantly reducing the incidence of bradycardia. These findings support the consideration of norepinephrine as an effective alternative vasopressor for maintaining maternal hemodynamics during CS under SAB.

The corrected carotid artery flow time and carotid peak velocity variation do not predict spinal anesthesia-induced hypotension: A prospective observational study.

Study objectiveA common side effect of spinal anesthesia is spinal anesthesia-induced hypotension (SAIH). The preoperative prediction of SAIH may prevent hypotension-related complications. Carotid Doppler ultrasound enables non-invasive assessment of the corrected carotid flow time (ccFT) and the carotid peak velocity variation (ΔVpeakCCA). This study aimed to evaluate the ability of ccFT and ΔVpeakCCA to predict SAIH. DesignProspective, observational, single-center study. SettingOperating room. Participants42 patients presenting for elective surgery under spinal anesthesia. InterventionsAt the holding area, the ccFT and ΔVpeakCCA were assessed with carotid Doppler ultrasound by a novice and experienced sonographer. MeasurementsIn the operating room, the occurrence of hypotension was observed for 10 min after an intrathecal injection of local anesthetic. The area under the receiver-operating curve (AUROC) was determined for ccFT and ΔVpeakCCA. The correlation between ccFT or ΔVpeakCCA and the change in blood pressure was evaluated. The interobserver agreement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Main resultsOf all patients, 43% experienced SAIH. The ccFT was 359 ± 30 ms in normotensive and 358 ± 18 ms in hypotensive patients (p = 0.91), while the ΔVpeakCCA was 7 [6–8] % in normotensive and 7 [6–11] % in hypotensive patients (p = 0.34). The AUROC was 0.52 [0.35–0.70] for ccFT and 0.59 [0.41–0.77] for ΔVpeakCCA. There was no correlation between the percentage change in blood pressure and the ccFT or ΔVpeakCCA. The ICC between sonographers was 0.93 [0.85–0.96], (p < 0.001) for ccFT and 0.76 [0.55–0.87], (p < 0.001) for ΔVpeakCCA. The bland-Altman analysis demonstrated acceptable accuracy and precision for ccFT. ConclusionsThe ccFT and ΔVpeakCCA do not predict the occurrence of SAIH. No correlation was found between these parameters and the percentage change in blood pressure after spinal anesthesia.

Effect of Intravenous Ondansetron on Spinal Anaesthesia-Induced Hypotension During Caesarean Section

Background: Spinal anaesthesia has become the preferred method for elective caesarean sections due to its simplicity, speed, and reliability. However, a significant challenge with this technique is maternal hypotension, which can lead to nausea, vomiting, and decreased cardiac output, necessitating effective preventive measures. Ondansetron, a 5-HT3 receptor antagonist, is commonly used to prevent nausea and vomiting, and recent studies suggest its potential efficacy in reducing hypotension during spinal anaesthesia. Objective: To compare the frequency of hypotension during spinal anaesthesia for elective caesarean delivery between two groups: one receiving intravenous ondansetron and the other receiving normal saline as a placebo. Methods: This randomized controlled trial was conducted at the Department of Anaesthesia, Combined Military Hospital Sialkot, over six months (May 6, 2016, to November 6, 2016). A total of 60 pregnant women scheduled for elective caesarean delivery under spinal anaesthesia, aged 18-35 years, classified as ASA I or II, and carrying a singleton pregnancy at 37-42 weeks, were included. Exclusion criteria included contraindications to spinal anaesthesia, history of heart or lung disease, known hypersensitivity to the study medication, diabetes with blood sugar &gt;180 mg/dl, hypertension with blood pressure &gt;160/90 mmHg, morbid obesity, and fetal abnormalities. Participants were randomly assigned to Group A (intervention) receiving 4 mg ondansetron intravenously in 10 ml saline 5 minutes before spinal anaesthesia, or Group B (control) receiving 10 ml saline intravenously. Baseline vitals, including heart rate, mean arterial pressure, systolic and diastolic blood pressure, were recorded. Spinal anaesthesia was administered using a 25-gauge needle with 2.5 ml of hyperbaric 0.5% bupivacaine solution. Hypotension was managed with intravenous bolus of 100 mcg phenylephrine and 100 ml normal saline. Data were analyzed using SPSS version 25.0, with qualitative variables compared using chi-square tests and significance set at p ≤ 0.05. Results: The mean age of participants was 27.95±5.68 years, and the mean BMI was 24.12±3.30 kg/m². Baseline systolic blood pressure averaged 129.00±11.24 mmHg, diastolic blood pressure 71.67±6.99 mmHg, and mean arterial pressure 114.67±7.93 mmHg. In Group A, 8 out of 30 participants (26.7%) experienced hypotension compared to 17 out of 30 participants (56.7%) in Group B (p=0.036). Stratification by age revealed a significant difference in hypotension incidence in participants &gt;26 years (p=0.028). No significant differences were observed when stratified by BMI &lt;24 kg/m² (p=0.056) and &gt;24 kg/m² (p=0.300). Conclusion: Administration of 4 mg intravenous ondansetron 5 minutes prior to spinal anaesthesia for elective caesarean delivery significantly reduces the frequency of hypotension compared to placebo, especially in patients older than 26 years. Ondansetron appears to be a practical and cost-effective prophylactic measure against spinal anaesthesia-induced hypotension, warranting further large-scale, multi-centre trials to validate these findings.

Norepinephrine or phenylephrine for the prevention of post-spinal hypotension after caesarean section: A double-blinded, randomized, controlled study of fetal heart rate and fetal cardiac output

Study objectiveSpinal anesthesia often causes hypotension, with consequent risk to the fetus. The use of vasopressor agents has been highly recommended for the prevention of spinal anesthesia-induced hypotension during caesarean delivery. Many studies have shown that norepinephrine can provide more stable maternal hemodynamics than phenylephrine. We therefore tested the hypothesis that norepinephrine preserves fetal circulation better than phenylephrine when used to treat maternal hypotension consequent to spinal anesthesia. DesignProspective, randomized, double-blinded study. SettingOperating room. PatientsWe recruited 223 parturients with uncomplicated singleton pregnancies who were scheduled for elective caesarean section under combined spinal-epidural anesthesia. InterventionsThe patients received prophylactic intravenous infusion of either 0.08 μg/kg/min norepinephrine or 0.5 μg/kg/min phenylephrine for prevention of spinal anesthesia-induced hypotension. MeasurementsChanges in fetal heart rate and fetal cardiac output before and after spinal anesthesia were measured using noninvasive Doppler ultrasound. Main results90 subjects who received norepinephrine infusion and 93 subjects who received phenylephrine infusion were ultimately analyzed in the present study. The effects of norepinephrine and phenylephrine on the change of fetal heart rate and fetal cardiac output at 3 and 6 min after spinal block were similar. Although there was a statistically significant decrease in fetal cardiac output at 6 min after subarachnoid block initiation in both the norepinephrine group (mean difference 0.02 L/min; 95% CI, 0–0.04 L/min; P = 0.03) and the phenylephrine group (mean difference 0.02 L/min; 95% CI, 0–0.04 L/min; P = 0.02), it remained within the normal range. ConclusionsProphylactic infusion of comparable doses of phenylephrine or norepinephrine has similar effects on fetal heart rate and cardiac output changes after spinal anesthesia. Neither phenylephrine nor norepinephrine has meaningful detrimental effects on fetal circulation or neonatal outcomes.

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

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 &lt; 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.

The ability of perfusion index and positional perfusion index variation to predict spinal anesthesia-induced hypotension in elderly patients: A prospective observational study

BackgroundSpinal anesthesia (SA) is a popular anesthetic technique for several surgeries; however, it is mostly associated with hypotension. The perfusion index (PI) can predict hypotension after spinal and general anesthesia. We aimed to evaluate the predictability of PI postural change, supine and sitting PI to post-SA hypotension in elderly patients. MethodsThis study was conducted on 68 elderly patients aged >65 years, scheduled for elective orthopedic surgical operations under SA in supine position. PI, arterial oxygen saturation, blood pressure, and heart rate were initially recorded at sitting and supine positions then 5, 10, and 20 min after subarachnoid drug injection (in supine position). ΔPI=PI supine−PI sitting. The relative change in PI (rPI) =ΔPI/PI sitting× 100. ResultsHypotension occurred in 33.82 % of patients. The Δ PI was 0.53±0.24, and the r PI was 14.18±6.41 %. Δ PI at cut-off >0.6 and r PI at cut-off > 14 %; could predict SA-induced hypotension with a sensitivity of 82.61 and 86.96 %, respectively, and specificity of 88.89 and 77.78 %, respectively. There was an insignificant difference between Δ PI and r PI and between r PI and baseline supine in predicting SA-induced severe hypotension. The prediction of SA-induced hypotension was higher with Δ PI than baseline sitting and baseline supine (P = 0.002 and 0.027) and between r PI and baseline sitting (P = 0.047). ConclusionsIn elderly patients, the Δ PI has a higher predictive value for SA-induced hypotension than baseline sitting and baseline supine with comparable prediction ability between Δ PI and r PI.

Preoperative echocardiography as a predictor of spinal anesthesia-induced hypotension in older patients with mild left ventricular diastolic dysfunction: a retrospective observational study.

Spinal anesthesia-induced hypotension (SAH) frequently occurs in older patients, many of whom have mild left ventricular (LV) diastolic dysfunction, often asymptomatic at rest. This study investigated the association between preoperative echocardiographic measurements and SAH in older patients with mild LV diastolic dysfunction. We conducted a retrospective observational study using data from electronic medical records. The patients ≥ 65 years old who underwent spinal anesthesia for urologic surgery between January 2016 and December 2017 and whose preoperative echocardiography within 6 months before surgery revealed grade I LV diastolic dysfunction were recruited. SAH was investigated using the anesthesia records. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. A total of 163 patients were analyzed. SAH and significant SAH developed in 55 (33.7%) patients. The mitral inflow E velocity was an independent risk factor for SAH (odds ratio [OR], 0.886; 95% confidence interval [CI], 0.845-0.929; P < 0.001). The area under the ROC curve for mitral inflow E velocity to predict SAH was 0.819 (95% CI, 0.752-0.875; P < 0.001). If mitral inflow E velocity was ≤ 60 cm/s, SAH was predicted with a sensitivity of 83.6% and specificity of 70.4%. The preoperative mitral inflow E velocity demonstrated the greatest predictability of SAH in older patients with mild LV diastolic dysfunction. This may assist in identifying patients at high risk of SAH and guiding preventive strategies in the future.

Use of vasopressors to manage spinal anesthesia-induced hypotension during cesarean delivery.

Cesarean sections are commonly performed under spinal anesthesia, which can lead to hypotension, adversely affecting maternal and fetal outcomes. Hypotension following spinal anesthesia is generally defined as a blood pressure of 80-90% below the baseline value. Various strategies have been implemented to reduce the incidence of spinal anesthesia-induced hypotension. The administration of vasopressors is a crucial method for preventing and treating hypotension. In the past decade, phenylephrine, a primarily alpha-adrenergic agonist, has been the preferred vasopressor for cesarean sections. Recently, norepinephrine, a potent alpha-agonist with modest beta-agonist activity, has gained popularity owing to its advantages over phenylephrine. Vasopressors can be administered via a bolus or continuous infusion. Although administering boluses alone is simpler in a clinical setting, continuous prophylactic infusion initiated immediately after spinal anesthesia is more effective in reducing the incidence of hypotension. Tailoring the infusion dose based on the patient's body weight and adjusting the rate in response to blood pressure changes, in addition to using a prophylactic or rescue bolus, helps reduce blood pressure variability during cesarean sections under spinal anesthesia until neonatal delivery.

The Management of Spinal and Epidural Anesthesia-Related Hypotension in the United States During Cesarean Childbirth.

This study delves into the prevalence of spinal anesthesia-induced hypotension during cesarean (c-section) childbirth, focusing on existing treatments and their efficacy. Currently, neuraxial analgesia is the most efficient method for alleviating pain during c-sections, but its major side effect, hypotension, necessitates a thorough understanding of the available treatment options. A scoping review was conducted using PubMed and Rayyan, with inclusion criteria being English peer-reviewed articles from the last five years, involving nulligravida/primigravida women under 35 years old in the United States. The research reveals various treatments to mitigate spinal anesthesia-induced hypotension. Norepinephrine and epinephrine have demonstrated effectiveness in maintaining blood pressure while reducing adverse maternal outcomes following delivery. When comparing fixed-rate infusions of norepinephrine to phenylephrine, norepinephrine demonstrated lower rates of bradycardia (p=0.004), thereby reducing the necessity for bolus atropine rescue (p=0.01). Furthermore, the use of colloid solutions during c-sections significantly decreased the incidence of hypotension when compared to crystalloid solutions (p<0.00001). Non-pharmacological methods, such as lower extremity wrapping and elevation, exhibited higher systolic and diastolic blood pressures, along with higher usage of ephedrine when compared to control groups. Pharmacological treatments proved more effective than non-pharmacological interventions in preventing maternal hypotension during c-sections. Notably, colloid preloading emerged as the most effective approach, helping to maintain maternal blood pressure, cardiac output, and heart rate while also minimizing the amount of ephedrine required and reducing anesthesia-related adverse effects. However, the study suggests the need for further investigations to determine the optimal dosage for colloid preloading. This research provides valuable insights into enhancing maternal well-being during c-sections by addressing the issue of neuraxial anesthesia-induced hypotension.

Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial.

Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.