PREVENTING HYPOTENSION CAUSED BY SPINAL ANESTHESIA IN NON PREECLAPMTIC PREGNANCIES WITH CAESAREAN SECTION
General Practitioner at Navy Base Clinic, Denpasar, Indonesia
Specialist in Anesthesiology and Intensive Therapy at Soedibjo Sardadi Naval Hospital, Indonesia
DOI:
https://doi.org/10.56943/jsh.v2i3.392Introduction. Caesarean method widely used and become popular among pregnant women. In general, this method mostly used regional anesthesia (spinal, epidural and CSE). However, many reports incidence of complication related to spinal anesthesia after the procedure. Maternal hypotension is the most common complication after spinal anesthesia procedure. Therefore, anesthesiologist need to prevent hypotension during spinal anesthesia in caesarean section. Method. The researcher examines several scientific journals from PubMed, BJA, Elsevier, Cochrane Library and BMC research until 10th August, 2023 for abstracts, conference proceedings, and full-text papers that evaluated prevention of hypotension in non-preeclampsia patients undergoing caesarean delivery under spinal anesthesia. In addition, the researchers examine the research conducted during 2016 to 2023. Result & Analysis. The researchers examine 28 scientific article (11.153 parturient) with 6 different methods to prevent hypotension. It was found that vasopressor is widely used in most research with incidence of hypotension varied from 4%-87,4%. IVCU studies reported the incidence of hypotension in 15,3%-43%. Leg Elevation a non-invasive technique studies reported the incidence of hypotension in 33,3-41,4%. Injection speed adjustment methods resulted incidence of hypotension in Fast injection 50 %-75% and Slow Injection in 36,7%-61%. In addition, granisetron methods diluted in normal saline reported the incidence of hypotension in 17,5%-42%. Low dose spinal anesthesia studies reported incidence of hypotension in 0% - 62,9%. Discussion. From all the research that has been reviewed, vasopressor (Phenylephrine), Leg Elevation and low dose spinal anesthesia could become primary options to prevent hypotension during spinal anesthesia in caesarean section since its effective to prevent hypotension, cost effective, and easy to applied in every medical facility.
Keywords: Caesarean Section Hypotension Vasopressors Granisetron IVCU
Aksoy, M. et al. (2021) ‘Granisetron or ondansentron to prevent hypotension after spinal anesthesia for elective cesarean delivery: A randomized placebo-controlled trial’, Journal of Clinical Anesthesia, 75, p. 110469. Available at: https://doi.org/10.1016/j.jclinane.2021.110469.
Andrade, P.A., Ortiz, Y.M. and Gamón, A.Á. (2018) ‘Norepinephrine and Etilefrin as Prevention of Maternal Hypotension in Cesarean Section Under Spinal Anesthesia’, Revista Científica Ciencia Médica, 21(1), pp. 68–77.
Arif, S.K. and Setiawan, I. (2015) ‘Perbandingan Efek Kecepatan Injeksi 0,4 ml/dtk Dan 0,2 ml/dtk Prosedur Anestesi Spinal Terhadap Kejadian Hipotensi Pada Seksio Sesaria’, JAI (Jurnal Anestesiologi Indonesia), 7(2), p. 79. Available at: https://doi.org/10.14710/jai.v7i2.9821.
Assen, S., Jemal, B. and Tesfaye, A. (2020) ‘Effectiveness of Leg Elevation to Prevent Spinal Anesthesia-Induced Hypotension during Cesarean Delivery in the Resource-Limited Area: Open Randomized Controlled Trial’, Anesthesiology Research and Practice, 2020, pp. 1–8. Available at: https://doi.org/10.1155/2020/5014916.
Ceruti, S. et al. (2018) ‘Prevention of arterial hypotension after spinal anaesthesia using vena cava ultrasound to guide fluid management’, British Journal of Anaesthesia, 120(1), pp. 101–108. Available at: https://doi.org/10.1016/j.bja.2017.08.001.
Chatterjee, A. et al. (2020) ‘Effectiveness of Granisetron in Prevention of Hypotension Following Spinal Anaesthesia in Patients Undergoing Elective Caesarean Section’, Cureus, 12(12). Available at: https://doi.org/10.7759/cureus.12113.
Chen, W. et al. (2020) ‘The Analysis of Risk Factors to Hypotension Occurring after Caesarean Spinal Anesthesia for Parturients with Scarred Uterus’, Research Square [Preprint].
Chiang, C.F. et al. (2017) ‘Injection speed of spinal anaesthesia for Caesarean delivery in Asian women and the incidence of hypotension: A randomised controlled trial’, Journal of Clinical Anesthesia, 39, pp. 82–86. Available at: https://doi.org/10.1016/j.jclinane.2017.03.025.
Gunda and Bekkam (2021) ‘Comparison of prophylactic ephedrine with crystalloid preloading for prevention of hypotension due to spinal anaesthesia for caesarian sections’, International Journal of Medical Research and Health Sciences, 10(12), pp. 87–90.
Guo, L. et al. (2022) ‘Prophylactic norepinephrine or phenylephrine infusion for bradycardia and post-spinal anaesthesia hypotension in patients with preeclampsia during Caesarean delivery: a randomised controlled trial’, British Journal of Anaesthesia, 128(5), pp. e305–e307. Available at: https://doi.org/10.1016/j.bja.2022.01.027.
Hasanin, A. et al. (2017) ‘Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial’, BMC Anesthesiology, 17(1), p. 60. Available at: https://doi.org/10.1186/s12871-017-0349-8.
Karnina, R., Rahmadani, S. and Faruk, M. (2022) ‘Incidence of Hypotension, Bradycardia, and Post-operative Nausea and Vomiting with Spinal Anesthesia in Cesarean Section Patient’, Open Access Macedonian Journal of Medical Sciences, 10(B), pp. 1602–1606. Available at: https://doi.org/10.3889/oamjms.2022.9024.
Mahdystira, H. et al. (2022) ‘Perbandingan Low Dose Spinal Anesthesia dan Non-Low Dose Spinal Anesthesia Terhadap Hemodinamik dan Penggunaan Efedrin Sectio Caesarea’, Muhammadiyah Journal of Midwifery, 3(1), p. 37. Available at: https://doi.org/10.24853/myjm.3.1.37-43.
McDonnell, N.J. et al. (2017) ‘A randomised double-blind trial of phenylephrine and metaraminol infusions for prevention of hypotension during spinal and combined spinal-epidural anaesthesia for elective caesarean section’, Anaesthesia, 72(5), pp. 609–617. Available at: https://doi.org/10.1111/anae.13836.
Mwaura, L. et al. (2016) ‘A randomised controlled trial comparing weight adjusted dose versus fixed dose prophylactic phenylephrine infusion on maintaining systolic blood pressure during caesarean section under spinal anaesthesia’, African Health Sciences, 16(2), p. 399. Available at: https://doi.org/10.4314/ahs.v16i2.8.
Ni, T. et al. (2022) ‘Inferior Vena Cava Collapsibility Index Can Predict Hypotension and Guide Fluid Management After Spinal Anesthesia’, Frontiers in Surgery, 9. Available at: https://doi.org/10.3389/fsurg.2022.831539.
Park, J.-H. et al. (2020) ‘The efficacy of intramuscular ephedrine in preventing hemodynamic perturbations in patients with spinal anesthesia and dexmedetomidine sedation’, International Journal of Medical Sciences, 17(15), pp. 2285–2291. Available at: https://doi.org/10.7150/ijms.48772.
Rana, A.A. et al. (2016) ‘Frequency of Complications of Spinal Anaesthesia for Caesarean Delivery’, Pakistan Journal of Medical & Health Sciences, 10(3), pp. 1044–1046.
Regmi, B.D.S. et al. (2019) ‘Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section’, Journal of Chitwan Medical College, 9(2).
Riffard, C. et al. (2018) ‘The pupillary light reflex for predicting the risk of hypotension after spinal anaesthesia for elective caesarean section’, Anaesthesia Critical Care & Pain Medicine, 37(3), pp. 233–238. Available at: https://doi.org/10.1016/j.accpm.2016.10.004.
Samarah, W. et al. (2020) ‘The effect of ondansetron administration 20 minutes prior to spinal anaesthesia on haemodynamic status in patients undergoing elective caesarean section: A comparison between two different doses’, Indian Journal of Anaesthesia, 64(11), p. 954. Available at: https://doi.org/10.4103/ija.IJA_974_19.
Sari, M.D. and Ozyurt, E. (2022) ‘Does Leg Raising Prevent Spinal-Induced Hypotension in Elective Cesarean Sections? A Randomized Controlled Study’, Journal of Anesthesiology and Reanimation Specialists’ Society, 30(3), pp. 182–187. Available at: https://doi.org/10.54875/jarss.2022.25348.
Shah, A.A. et al. (2018) ‘Efficacy Of Phenylephrine Infusion Verses Colloid Preloading In Resolving Hypotension Due To Spinal Anaesthesia During Caesarean Section’, J Ayub Med Coll Abbottabad, 30(3), pp. 377–380.
Shitemaw, T. et al. (2020) ‘Incidence and associated factors for hypotension after spinal anesthesia during cesarean section at Gandhi Memorial Hospital Addis Ababa, Ethiopia’, PLoS One. Edited by R.Q. Gurgel, 15(8), p. e0236755. Available at: https://doi.org/10.1371/journal.pone.0236755.
Supriyanto, J., Suwarman and Rachman, I.A. (2020) ‘Efek Granisetron Intravena terhadap Perubahan Tekanan Darah pada Seksio Sesarea dengan Anestesi Spinal’, Jurnal Anestesi Perioperatif, 8(2), pp. 99–107. Available at: https://doi.org/10.15851/jap.v8n2.2041.
Tugcugil, E. and Besir, A. (2022) ‘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’, Clinical and Experimental Obstetrics & Gynecology, 49(7), p. 152. Available at: https://doi.org/10.31083/j.ceog4907152.
Wahid, M. et al. (2022) ‘Granisetron versus Ondansetron: Comparison of 5HT3 antagonists in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients’, Pakistan Journal of Medical Sciences, 38(7). Available at: https://doi.org/10.12669/pjms.38.7.5585.
Weiniger, C.F. et al. (2021) ‘Association Between Hyperbaric Bupivacaine Dose and Maternal Hypotension: Retrospective Database Study of 8226 Women Undergoing Cesarean Delivery Under Spinal Anesthesia’, Anesthesia & Analgesia, 133(4), pp. 967–975. Available at: https://doi.org/10.1213/ANE.0000000000005518.
Xiao, F. et al. (2021) ‘A Randomized Double-Blinded Dose-dependent Study of Metaraminol for Preventing Spinal-Induced Hypotension in Caesarean Delivery’, Frontiers in Pharmacology, 12. Available at: https://doi.org/10.3389/fphar.2021.608198.
Xue, X., Wang, J. and Zhou, M. (2023) ‘Dose-effect relationship of metaraminol before spinal anesthesia in preventing hypotension induced by spinal anesthesia in parturients undergoing cesarean section’, Research Square, pp. 1–14.
Yao, S.-F. et al. (2021) ‘The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery’, BMC Anesthesiology, 21(1), p. 22. Available at: https://doi.org/10.1186/s12871-021-01242-8.
Zhou, Y. et al. (2022) ‘Comparison of Metaraminol, Phenylephrine, and Norepinephrine Infusion for Prevention of Hypotension During Combined Spinal-Epidural Anaesthesia for Elective Caesarean Section: A Three-Arm, Randomized, Double-Blind, Non-Inferiority Trial’, Drug Design, Development and Therapy, Volume 16, pp. 117–127. Available at: https://doi.org/10.2147/DDDT.S331177.
