Determination of maternal and anaesthesia related risk factors and incidence of spinal anaesthesia induced hypotension in elective caesarean section – A Clinical Study

Abstract

Abstract

In contemporary times, spinal anaesthesia (SA) has emerged as the preferred modality for anaesthesia during caesarean sections (CS). However, it is linked to substantial hemodynamic ramifications, notably maternal hypotension. This investigation endeavours to assess an extensive array of variables, encompassing factors related to the parturient and nuances in anaesthesia techniques. The focal point is to scrutinize the correlation between these factors and the manifestation of varying degrees of hypotension induced by SA in the context of elective CS procedures.

Method:

This prospective investigation engaged a cohort of 624 mother-infant pairs, wherein the maternal subjects underwent elective Caesarean Section (CS) under the administration of Spinal Anaesthesia (SA). Data compilation followed a meticulously designed proforma encompassing three distinct segments: the parturient profile, anaesthetic methodologies, and a tabulated framework for meticulous documentation of maternal blood pressure dynamics.

The underlying hypothesis posited a correlation between specific maternal attributes, exemplified by age, and anaesthesia-associated risk factors, with block height serving as a prime example. The primary focus of this study was to unravel the intricate interplay of these factors in precipitating SA-induced hypotension during elective CS procedures.

Result:

In the recent investigation, the occurrence rates of mild, moderate, and severe hypotension stood at 25%, 30%, and 45%, respectively. Notably, a profound exploration unveiled a novel set of ten risk factors intricately tied to hypotensive incidents. These factors encompassed elements like maternal age surpassing 40 years, a body mass index equal to or exceeding 28 kg/m², a weight gain spanning 15-25 kg, gravidity equal to or exceeding six, a history marked by instances of hypotension, baseline systolic blood pressure (SBP) below 115 mmHg, and a baseline heart rate exceeding 110 beats per minute, elucidated in maternal modeling. Additionally, factors such as fluid preloading exceeding 1200 ml, the introduction of sufentanil alongside bupivacaine, and the elevation of sensory block height beyond T5 within the anaesthesia-related modeling, all exhibited substantial associations with hypotension (P < 0.05).

Conclusion:

 The study pinpointed age, body mass index, weight gain, gravidity, history of hypotension, baseline systolic blood pressure, heart rate, fluid preloading, the incorporation of sufentanil alongside bupivacaine, and sensory block height as the primary determinants associated with hypotension induced by Spinal Anaesthesia during Caesarean Section.