Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anesthesia between Normotensive and Hypertensive Women Undergoing Elective Cesarean Section

ABSTRACT

Introduction: Spinal anesthesia (SA) is the technique of choice in cesarean sections, but it is not widely accepted in hypertensiondue to fear of sudden and extensive sympathetic blockade. Sympathetic blockade induced hypotension may occur in up to64–100% of pregnant women who have been given spinal anesthesia for cesarean delivery, especially when hyperbaric solutionsare used. Severely pre-eclamptic patients were previously believed to be at high risk of severe hypotension, with maternaland fetal consequences because of reduced plasma volume and because of the need to limit i.v. fluids to avoid iatrogenicpulmonary edema.Methodology: The present study, “comparison of hemodyanamic response and vasopressor requirement following spinalanesthesia between normotensive and hypertensive women undergoing elective cesarean section” 100 women of age20–35 years, the American Society of Anesthesiologists physical Status Ι and ΙΙ carrying a singleton pregnancy and scheduledto have elective cesarean section in Netaji Subhash Chandra Bose Medical College, Jabalpur, were enrolled into two groups.GroupA 50 were normotensive women and Group B 50 were hypertensive women. All patients received a standard subarachnoidblock under all aseptic precautions with 12.5 mg 0.5% hyperbaric bupivacaine.Results: Based on the data from our study, it could be concluded that after spinal anesthesia in patients undergoing electivecesarean section-hypertensive group of parturients had less fall in mean systolic blood pressure (SBP), diastolic BP, and meanarterial BP in comparison to normal healthy pregnant women which were statistically significant (P < 0.05). Hypertensive group ofpatients required less ephedrine to treat hypotension in comparison to normotensive patients which were statistically significant(P < 0.05). The incidence of hypotension was almost 7 times less in hypertensive parturients than healthy parturients (oddsratio = 23.14, relative risk of hypotension in Group A = 7.2, confidence interval = 7.6–70.3).Conclusion: To summarize, our results showed that hypotension following SA administered for cesarean section wassignificantly less in hypertensive patient than in healthy pregnant women. In addition, vasopressor requirements were also lessin hypertensive parturients and neonatal outcome was comparable between the two groups. Therefore, subarachnoid blockis an acceptable technique to perform in hypertensive parturients due to its virtue of simplicity, rapidity, cost-effectiveness,and intensity of block.