Incidence and Risk Factors Associated with Spinal Anesthesia Induced Predelivery Hypotension for Cesarean Section
Abstract
Objective: To investigate the incidence of predelivery hypotension and identify risk factors associated with spinal anesthesia-induced predelivery hypotension for cesarean section.
Materials & methods: A prospective cohort study was conducted from July 1, 2014 to March 15, 2015 on 583 patients undergoing cesarean section under spinal anesthesia. Preloading with intravenous 0.9% NaCl 10 ml/kg before performing spinal anesthesia with 0.5% hyperbaric bupivacaine 2.2 ml plus preservative-free morphine 0.2 mg and turning the patient to supine position with left uterine displacement. Predelivery hypotension (systolic blood pressure < 80% of baseline or <90 mmHg) was treated by intravenous phenylephrine 100 mcg Data were analyzed using multivariable logistic regression and AuROC.
Results & Discussion: Incidence of predelivery hypotension was 61.7% (95% CI: 57.7, 65.7). The probability of predelivery hypotension increased with supine hypotensive syndrome of pregnancy (SHSP) (adjusted OR 3.82, 95% CI 1.07, 13.59, p=0.04, AuROC 0.69). The other risk factors were anesthetic level at the 5 minute, as compared to T12-T5 level, the incidence increased to 2.85 times (95% CI 1.89, 4.3, p<0.001) and 7.65 times (95% CI 2.66, 22.04, p<0.001) in the T4-T 1 range and C5-C1 range, respectively and the indication of cesarean section, in a comparison with oligohydramnios, the incidence increased to 2.20 times (95% CI 1.31, 3.70, p=0.003) and 2.35 times (95% CI 1.37, 4.00, p=0.002) in cephalopelvic disproportion (CPD) and previous cesarean section, respectively.
Conclusion: The results indicated that the incidence of spinal anesthesia induced predelivery hypotension for cesarean section increased with SHSP, anesthetic level at the 5th minute upper T5 level, especially C level. CPD and previous cesarean section were related with higher incidence than oligohydramnios.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
