HYPOTENSION AFTER SPINAL

ANESTHESIA FOR CESAREAN

SECTION
IDENTIFICATION OF RISK FACTORS USING AN
ANESTHESIA INFORMATION MANAGEMENT SYSTEM
Rio Yansen Cikutra (112015140)
Yuviani (112015184)
 INTRODUCTION
Spinal anesthesia (SA) for SC the most employed
anesthesia technique
Lower relative mortality risk compared to GA
Still associated with considerable side effects
hypotension is the most frequent
Hypotension low uterine perfusion neonatal acidosis
 Objective
To determine risk factors for developing hypotension after
spinal anesthesia for cesarean section to prevent obstetric
patients from hypotensive episodes potentially resulting in
intrauterine malperfusion and endangering the child
 Methods and Materials
Data acquisition
Computerized anesthesia records generated during SC under SA
conducted at tertiary care teaching hospital between July 1, 2002
December 31, 2004
MAP, SAP, DAP were recorded every 2 min until birth using NIBP, and
at least every 5 min following parturition
Baseline BP mean value of the first three consecutive
measurements after connecting patient to the monitoring unit
Hypotension : decrease in MAP <20% from baseline or drop of SAP
below 90 mmHg for a minimum duration 0f 10 min
 Methods and Materials
Anesthesia techniques
Women receiving SA were preloaded with at least 500 ml of
crystalloid or colloid fluids (Ringer or hydroxyethil starch)
Monitoring NIBP, ECG, SpO2
SA was performed in a sitting position with a 25G Sprotte needle,
inserted between L3/L4 or L2/L3 2.5 ml (0.4) of plain Bupivacaine
0.5% and, partly, Fentanyl between 10 and 20 lg (0.20.4 ml)
Sensory block height measured 10 min after application loss of
cold sensation to alcohol
 Results
The anesthesia records of 503 patients meeting criteria
of hypotension: 284 patients (56.5%)
Age, weight, BMI, sensory block height and birth weight
of the neonate were identified by univariate analysis as
having an association with a higher incidence of
hypotension in the mother following SA for cesarean
section
age > 35, BMI > 29 kg/m2 and peak sensory block height
heights > Th6 showed the strongest association
Results
 Discussion
SC is constantly gaining popularity SA became the preferred
method of anesthesia for this procedure
Lower relative mortality risk compared to GA
Still associated with considerable side effects hypotension is
the most frequent
Hypotension : decrease in MAP <20% from baseline or drop of
SAP below 90 mmHg for a minimum duration 0f 10 min
The changed physiology of the parturient could be a reason for
the high incidence of hypotension after SA
 Discussion
Three independent variables having an association with
hypotension after SA induction for SC
The risk of hypotension increased by 1.6 times with each
additional risk factor
BMI dichotomized variable cut off point of 29 kg/m2
Age cut off point of 35 years significantly lower
incidence of hypotension than in older ones
 Discussion
Circulatory regulation is affected by a blockade of the sympathetic
nervous system with resulting reductions in both venous return and
systemic vascular resistance
Level of analgesia exceeds Th4 cardiac acceleratory fibres are
blocked decrease in heart rate and cardiac output
Strategies of reducing the incidence of spinal hypotension:
administration of IV fluids
positioning of the patient
use of heart rate variability measures
by the prophylactic and/or therapeutic use of vasoactive drugs
 Conclusion
BMI, age, and sensory block height as independent risk
factors for hypotension
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