100 Impact of preoperative oral rehydration on the incidence of post-spinal hypotension for scheduled cesarean section

Aims: Spinal anesthesia is the choice of anesthesia in parturient for cesarean section. This procedure is frequently associated with hypotension and the incidence varies from 70% to 80%. Maternal hypotension causes very unpleasant sign and symptoms such as nausea, vomiting, dyspnoea and sense of impending doom. Prolonged episodes of hypotension lead to organ ischemia, loss of consciousness, cardiovascular collapse and uteroplacental hypoperfusion. The aim of this study is to find out the proper data of the incidence of hypotension in parturient undergoing cesarean section in our hospital as only the estimated data is present. Methods: We retrospectively reviewed the intraoperative anesthesia record form of all the patients who underwent cesarean section under spinal anesthesia from the hospital record section from 13th April 2016 to 12th April 2017. The detailed parameters of patient’s demographic data were collected and recorded. Results: A total of 3814 parturients were included in this study. The mean age was 25.76 ± 4.74 years and mean gestational age was 39.23 ± 1.54 weeks. Post spinal hypotension was seen in 947 patients out of 3814. Thus the incidence of hypotension was 24.8%. Conclusions: The incidence of maternal hypotension is very high if prophylactic measures are not taken. The fluid preloading or coloading, left lateral uterine displacement and prophylactic vasopressors have shown to be effective in preventing postspinal hypotension.

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Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23394 ◽

2018 ◽

Vol 1 (2) ◽

pp. 70-74

Author(s):

Rohini Sigdel ◽

Maya Lama ◽

Sanish Gurung ◽

Bishal Gurung ◽

Anil Prasad Neupane ◽

...

Keyword(s):

Cesarean Section ◽

Spinal Anesthesia ◽

Elective Cesarean Section ◽

Controlled Study ◽

Control Group ◽

Operating Table ◽

Hemodynamic Effects ◽

Elective Cesarean ◽

Spinal Hypotension ◽

The Right

Background: Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby. Methods: One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded. Results: The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had vomiting. Conclusion: In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.

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