Department of Anesthesiology and Intensive Care, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.
Department of Obstetrics and Gynaecology, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, Nepal.
Kathmandu Univ Med J (KUMJ). 2021;19(73):85-89.
Background Spinal anaesthesia is the current standard for caesarean section. Hypotension, a common complication, potentially results in adverse foetal and maternal outcomes. However, hypotension-defining criteria are varied. Objective To identify the blood pressure thresholds for spinal anaesthesia-induced hypotension during caesarean section. Method This is a retrospective cohort study of spinal anaesthesia-induced hypotension that occurred till baby-delivery during caesarean section. Reports on intraoperative hypotension, collected previously from January to December 2019, were reviewed to identify the hypotension-defining thresholds. The thresholds were categorized into systolic blood pressure (SBP) of 80, 90 or 100 mmHg, mean arterial pressure (MAP) of 60, 65 or 70 mmHg, combinations, and others. Parturient and anaesthesia characteristics, and associated hypotensive symptoms were also recorded for descriptive analysis. Result Spinal anaesthesia-induced hypotension was identified in 129 (11.5%) cases among 1116 caesarean sections. Altogether, 12 hypotension-defining thresholds were employed. Thresholds of SBP 90, MAP 60, and SBP 80 mmHg were used in 53 (41%), 28 (21.7%), and 21 (16.2%) cases respectively. Mean maternal age was 28 (±4.22) years and 87 (67.4%) cases underwent emergency surgery. Median sensory blockade level was T4. Nausea-vomiting, bradycardia, and tachycardia were associated during five (3.8%), six (4.6%), and 15 (11.6%) hypotensive incidents respectively. Two cases had unrecordable blood pressure but there was no maternal mortality. Conclusion Systolic blood pressure of 90 mmHg and mean arterial pressure of 60 mmHg included the most common thresholds for spinal anaesthesia-induced hypotension during caesarean section. Identifying the safe and clinically relevant hypotension-defining criteria needs further investigation.
椎管内麻醉是剖宫产的当前标准。低血压是一种常见的并发症，可能导致母婴不良结局。然而，低血压的定义标准存在差异。目的：确定剖宫产期间椎管内麻醉引起低血压的血压阈值。方法：这是一项回顾性队列研究，研究对象为椎管内麻醉引起的低血压，发生在剖宫产术中分娩前。回顾了 2019 年 1 月至 12 月期间术中低血压的报告，以确定低血压的定义阈值。这些阈值分为收缩压（SBP）80mmHg、90mmHg 或 100mmHg、平均动脉压（MAP）60mmHg、65mmHg 或 70mmHg、组合和其他。还记录了产妇和麻醉特征以及相关的低血压症状，以便进行描述性分析。结果：在 1116 例剖宫产术中，有 129 例（11.5%）发生了椎管内麻醉引起的低血压。总共使用了 12 个低血压定义阈值。SBP90mmHg、MAP60mmHg 和 SBP80mmHg 的阈值分别在 53 例（41%）、28 例（21.7%）和 21 例（16.2%）中使用。产妇平均年龄为 28（±4.22）岁，87 例（67.4%）为急诊手术。中位感觉阻滞平面为 T4。恶心呕吐、心动过缓、心动过速分别与 5 例（3.8%）、6 例（4.6%）和 15 例（11.6%）低血压事件相关。有 2 例记录的血压不可用，但没有产妇死亡。结论：SBP90mmHg 和 MAP60mmHg 包括剖宫产期间椎管内麻醉引起低血压最常见的阈值。确定安全且具有临床相关性的低血压定义标准需要进一步研究。
