การสำรวจแนวทางปฏิบัติของวิสัญญีแพทย์ในการจัดการภาวะความดันโลหิตต่ำจากการระงับความรู้สึกด้วยยาชาทางช่องน้ำไขสันหลังระหว่างการผ่าตัดคลอดทางหน้าท้องในประเทศไทย

Ratikorn Anusorntanawat

doi:10.33165/rmj.2023.46.1.260309

Authors

Ratikorn Anusorntanawat Department of Anesthesia, Chaophrayayommarat Hospital, Suphan Buri, Thailand

DOI:

https://doi.org/10.33165/rmj.2023.46.1.260309

Keywords:

Spinal anaesthesia, Hypotension, Anesthesiologist, Caesarean section

Abstract

Background: The international consensus for management of spinal anaesthesia-induced hypotension (SAIH) during caesarean section advocates the prophylaxis with phenylephrine, colloid preloading or crystalloid coloading, and left uterine displacement (LUD), to maintain systolic arterial pressure (SAP) higher than 90% and avoid a decrease lower than 80% of baseline.

Objective: To explore Thai anesthesiologists’ practices for management of SAIH during caesarean section.

Methods: An online questionnaire survey was sent to 152 anesthesiologists during the period from September to October 2022. Data collection included personal information and the management of SAIH.

Results: Of 152 anesthesiologists, 90.1% were graduated anesthesiologists, 44.1% were between 10 to 19 years of work experience, and 36.2% were academic institution. Most of them (96.7%) used both prophylaxis and treatment for management of SAIH. For prophylaxis, 45.4% used 2 combined methods (intravenous fluid and LUD), 38.1% did not use vasopressors, 29.6% used ephedrine, and 9.2% used ephedrine and phenylephrine. For treatment, 51.3% used 3 combined methods (vasopressor, intravenous fluid, and LUD), 38.2% ephedrine and noradrenaline, and 19.7% used ephedrine and phenylephrine. Treatments for SAP below 100 mmHg and less than 80% of baseline were 36.8% and 31.5%, respectively. Only 49.3% had available phenylephrine in their hospitals.

Conclusions: This finding showed that methods and concepts for management of SAIH in Thailand were different from the international guideline. Available phenylephrine in all hospitals for prophylaxis and early treatment of decreased SAP should be promoted.

References

Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg. 2012;114(2):377-390. doi:10.1213/ANE.0b013e3182373a3e

Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;(4):CD002251. doi:10.1002/14651858.CD002251.pub2

Ohpasanon P, Chinachoti T, Sriswasdi P, Srichu S. Prospective study of hypotension after spinal anesthesia for cesarean section at Siriraj Hospital: incidence and risk factors, Part 2. J Med Assoc Thai. 2008;91(5):675-680.

Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. J Med Assoc Thai. 2008;91(2):181-187.

Russell IF. Spinal anaesthesia for caesarean section. the use of 0.5% bupivacaine. Br J Anaesth. 1983;55(4):309-314. doi:10.1093/bja/55.4.309

Kinsella SM, Carvalho B, Dyer RA, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71-92. doi:10.1111/anae.14080

National Drug Information. Phenylephrine. August 31, 2022. Accessed December 23, 2022. http://ndi.fda.moph.go.th/drug_detail/index/?ndrug=5&rctype=1C&rcno=6215031&lpvncd=&lcntpcd=&lcnno=&licensee_no=

The Royal College of Anesthesiologists of Thailand (RCAT) Facebook page. Log in or sign up to view. August 5, 2022. Accessed December 23, 2022. https://www.facebook.com/rcatofficial

Anusorntanawat R, Uerpairojkit K, Thongthaweeporn N, Charuluxananan S. Safety of phenylephrine in antihypotensive treatment during spinal anesthesia for cesarean section. J Med Assoc Thai. 2016;99(2):188-196.

Anusorntanawat R. A comparison of phenylephrine administration between intravenous bolus and slow injection in treatment of spinal anesthesia-induced hypotension on bradycardia and other side effects in patients undergoing cesarean section: a randomized, single-blind study. Thai J Anesthesiol. 2020;46(2):80-87.

Anusorntanawat R. A comparison of prophylactic phenylephrine administration between 50 and 100 micrograms intravenous slow injection on hypotension, bradycardia and other side effects after spinal anesthesia in patients undergoing cesarean section: a randomized, single-blind study. Thai J Anesthesiol. 2023;49(1):37-46

Ismail S, Sohaib M, Farrukh F. Management of spinal-induced hypotension for elective caesarean section: a survey of practices among anesthesiologists from a developing country. Afr Health Sci. 2020;20(4):1918-1926. doi:10.4314/ahs.v20i4.50

Sertznig C, Vial F, Audibert G, Mertes PM, El Adssi H, Bouaziz H. Management of hypotension during spinal anaesthesia for elective caesarean section: a survey of practice in Lorraine region. Ann Fr Anesth Reanim. 2011;30(9):630-635. doi:10.1016/j.annfar.2011.03.02