Risk factors of more severe hypotension after spinal anesthesia for cesarean section
- PMID: 38252496
- DOI: 10.1097/JCMA.0000000000001056
Risk factors of more severe hypotension after spinal anesthesia for cesarean section
Abstract
Background: The aim of this study was to examine the risk factors associated with the use of vasopressors to prevent hypotension that occurs after spinal anesthesia during cesarean section. Although the prophylactic use of vasopressors is already suggested as routine care in many parts of the world, the occurrence of spinal anesthesia-induced hypotension (SAIH) is still common in parturients.
Methods: This retrospective study included parturients receiving elective cesarean deliveries under spinal anesthesia from April 2016 to March 2020. Risk factors related to ephedrine dosage were analyzed using a hurdle model, and risk factors related to SAIH were further analyzed with logistic regression.
Results: Five risk factors, namely maternal body mass index (BMI, p < 0.001), baseline systolic blood pressure (SBP, p < 0.001), baseline heart rate (HR, p = 0.047), multiparity ( p = 0.003), and large fetal weight ( p = 0.005) were significantly associated with the requirement for ephedrine. Furthermore, a higher ephedrine dosage was significantly associated with maternal BMI ( p < 0.001), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p = 0.027), large fetal weight ( p = 0.030), maternal age ( p = 0.009), and twin pregnancies ( p < 0.001). Logistic regression analysis also showed that the same five risk factors-maternal BMI ( p = 0.030), baseline SBP ( p < 0.001), baseline HR ( p < 0.001), multiparity ( p < 0.001), and large fetal weight ( p < 0.001)-were significantly associated with SAIH, even in cases where vasopressors were administered.
Conclusion: These findings can be useful for clinicians when deciding the dose of prophylactic ephedrine or phenylephrine to prevent SAIH.
Copyright © 2024, the Chinese Medical Association.
Conflict of interest statement
Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
Similar articles
-
Prevention of spinal hypotension during cesarean section: A systematic review and Bayesian network meta-analysis based on ephedrine, phenylephrine, and norepinephrine.J Obstet Gynaecol Res. 2023 Jul;49(7):1651-1662. doi: 10.1111/jog.15671. Epub 2023 May 12. J Obstet Gynaecol Res. 2023. PMID: 37170779 Review.
-
A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article.Medicine (Baltimore). 2019 Dec;98(51):e18311. doi: 10.1097/MD.0000000000018311. Medicine (Baltimore). 2019. PMID: 31860981 Free PMC article. Clinical Trial.
-
Phenylephrine vs ephedrine in cesarean delivery under spinal anesthesia: A systematic literature review and meta-analysis.Int J Surg. 2018 Dec;60:48-59. doi: 10.1016/j.ijsu.2018.10.039. Epub 2018 Oct 31. Int J Surg. 2018. PMID: 30389535
-
Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial.J Clin Anesth. 2017 Feb;37:43-48. doi: 10.1016/j.jclinane.2016.11.001. Epub 2016 Dec 26. J Clin Anesth. 2017. PMID: 28235526 Clinical Trial.
-
Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis.Acta Anaesthesiol Scand. 2012 Aug;56(7):810-6. doi: 10.1111/j.1399-6576.2011.02646.x. Epub 2012 Feb 7. Acta Anaesthesiol Scand. 2012. PMID: 22313496 Review.
References
-
- Benhamou D, Wong C. Neuraxial anesthesia for cesarean delivery: what criteria define the “optimal” technique? Anesth Analg. 2009;109:1370–3.
-
- Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103:645–53.
-
- Riley ET, Cohen SE, Macario A, Desai JB, Ratner EF. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg. 1995;80:709–12.
-
- Benhamou D, Bouaziz H, Chassard D, Ducloy JC, Fuzier V, Laffon M, et al. Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey. Eur J Anaesthesiol. 2009;26:694–700.
-
- Shibli KU, Russell IF. A survey of anaesthetic techniques used for caesarean section in the UK in 1997. Int J Obstet Anesth. 2000;9:160–7.
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous