Hypotension during spinal anaesthesia for Caesarean section in a resource limited setting: towards a consensus definition
South. Afr. j. anaesth. analg. (Online)
; 25(1): 38-42, 2019. ilus
Article
in English
| AIM
| ID: biblio-1272252
Responsible library:
CG1.1
ABSTRACT
Background:
Intraoperative hypotension following spinal anaesthesia for Caesarean section is associated with maternal morbidity and mortality. Because of inconsistent definitions the reported incidence of hypotension varies between 7% and 74%, making it almost impossible to set standard targets. Developing and adopting a clinically significant threshold for intraoperative hypotension will allow for benchmarking, comparison between studies, and consistency in guidelines and recommendations.Methods:
Common definitions for spinal hypotension were first identified from a recent systematic review of the literature and a consensus statement on spinal hypotension. These definitions were applied to haemodynamic data taken from a prospective interventional obstetric spinal hypotension study conducted at Edendale Hospital, to determine the incidence of hypotension when applying these different thresholds. Finally, a definition was proposed based on these incidences and a review of the relevant literature.Results:
Fifteen different definitions were identified. These were then applied to the study population with a resultant incidence of hypotension ranging from 15.8% to 91.4%. Based on a literature review of obstetric and other relevant perioperative and critical care medicine, targeting a mean arterial pressure > 70 mmHg and systolic blood pressure > 100 mmHg is recommended, and it is proposed that the lowest absolute values at which vasopressor therapy should be initiated are a mean arterial blood pressure < 65 mmHg or systolic blood pressure < 90 mmHg. Optimally, practitioners should maintain systolic blood pressure at greater than 90% of the baseline pre-spinal anaesthesia value.Conclusion:
This study confirmed a wide variation in the incidence of obstetric spinal hypotension in a South African setting, depending on the definition used. An absolute threshold for intervention with vasopressor and an optimal target relative to baseline blood pressure are suggested. Further work is required to establish the effect of the adherence to these recommendations on important maternal and foetaloutcomes:
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Index:
AIM (Africa)
Main subject:
South Africa
/
Cesarean Section
/
Hypotension
/
Anesthesia
Type of study:
Practice guideline
Country/Region as subject:
Africa
Language:
English
Journal:
South. Afr. j. anaesth. analg. (Online)
Year:
2019
Type:
Article
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