This is an outdated version published on 2022-12-30. Read the most recent version.

Incident of hypotension after performing spinal anesthesia during preloading of fluid gelatin and phenylephrine during spinal anesthesia compared with those with only fluid gelatin in patients undergoing cesarean section

Authors

Bundharika Artnasiaw Anesthesiologist, Chaiyaphum Hospital, Chaiyaphum Province

Keywords:

hypotension, spinal anesthesia, cesarean section, fluid gelatin, phenylephrine

Abstract

Introduction: Spinal anesthesia is recommended for those undergoing a cesarean section. As a result, the sympathetic autonomic nervous system is suppressed. The hypotension is a major side effect, which may result in a bradycardia or death in severe cases.

Objectives: To compare hypotension after spinal anesthesia during preloading (given before spinal anesthesia) between the administration of fluid gelatin and intravenous phenylephrine during spinal anesthesia and the administration of fluid gelatin only in patients undergoing cesarean section.

Methods: The study was conducted on the basis of randomized comparative trial, therapy (intervention) in female patients aged 18-44 years, 37-40 weeks gestational age, during 2020-2021 at Chaiyaphum hospital, Chaiyaphum province, Thailand. The index group consisted of patients given 500 mL of fluid gelatin preloading and intravenous 100 mcg phenylephrine during spinal anesthesia (GP). The comparison group consisted of patients given 500 ml of fluid gelatin preloading (G). Study size estimation is 42 cases per group.

Results: Each group consisted of 42 patients. The baseline data for both groups of patient and infants were not different. The mean age was 29 years, gestational age 38 weeks, weight 66 kg, BMI 26 kg/m². However, data during the intraoperative period showed that the GP group had less intraoperative blood loss than the G group (310.7±100.9 and 366.7±124.3, p=0.093) and had a high level of anesthesia (above level T4) greater than the G group (57.0% and 33.3%, p=0.048). The GP group had less hypotension than the G group, but this was not statistically significant (40.5% and 57.1%, p=0.190). When different factors such as blood loss and a high level of anesthesia, were adjusted difference by risk difference regression, it was found that patients in the GP group had hypotension less than the G group 21.06% with statistical significance. If a preventive method is used by giving GP to 5 patients, hypotension shall be reduced in 1 patient (NNT=5) and there were no significant differences of side effects in patients and infants.

Conclusion: The administration of 500 mL of fluid gelatin preloading with 100 mcg of phenylephrine given during spinal anesthesia undergoing cesarean section contribute to a lower incident of hypotension than the administration of a single fluid gelatin. Therefore, it may be considered to be given in good health patients who have undergone a cesarean section and not contraindicated with these drugs.

References

Hoyle J, Yentis SM. Assessing the height of block for caesarean section over the past three decades: trends from the literature. Anaesthesia, 2015;70(4):421-8.

Langesæter E, Dyer RA. Maternal haemodynamic changes during spinal anaesthesia for caesarean section. Curr Opin Anaesthesiol, 2011;24(3):242-8.

Ngan Kee WD, Khaw KS, Ng FF. Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section. Br J Anaesth, 2004;92(4):469-74.

ราชวิทยาลัยแห่งประเทศไทย. ประกาศราชวิทยาลัยวิสัญญีแพทย์แห่งประเทศไทย ปี 2562 เรื่องแนวทางเวชปฏิบัติในการทำ Spinal anesthesia. [Internet]. Available from: http://www.anesthai.org/th/files/documents/3 [Retrieved 15 September 2022].

Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology, 2016;124(2):270-300.

Mercier FJ, Augè M, Hoffmann C, Fischer C, Le Gouez A. Maternal hypotension during spinal anesthesia for caesarean delivery. Minerva Anestesiol, 2013;79(1):62-73.

รติกร อนุสรธนาวัฒน์. อุบัติการณ์และปัจจัยเสี่ยงที่เกี่ยวข้องกับภาวะความดันโลหิตต่ำในมารดาที่ได้รับการระงับความรู้สึกทางช่องน้ำไขสันหลังระหว่างการผ่าตัดคลอดทางหน้าท้อง. วารสารแพทย์เขต 4-5, 2015;34(4):267-79.

Lee SWY, Khaw KS, Ngan Kee WD, Leung TY, Critchley LAH. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. Br J Anaesth, 2012;109(6):950-6.

Kuhn JC, Hauge TH, Rosseland LA, Dahl V, Langesæter E. Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery: A Randomized, Double-Blind, Placebo-Controlled Study. Anesth Analg, 2016;122(4):1120-9.

Melchor JR, Espinosa Á, Hurtado EM, Francés RC, Pérez RN, Gurumeta AA, et al. Colloids versus crystalloids in the prevention of hypotension induced by spinal anesthesia in elective cesarean section. A systematic review and meta-analysis. Minerva Anestesiol, 2015;81(9):1019-30.

Fitzgerald JP, Fedoruk KA, Jadin SM, Carvalho B, Halpern SH. Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia, 2020;75(1):109-21.

Gunusen I, Karaman S, Ertugrul V, Firat V. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care, 2010;38(4):647-53.

Chooi C, Cox JJ, Lumb RS, Middleton P, Chemali M, Emmett RS, et al. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev, 2020;2020(7):CD002251.

Pamela F, Mark DR, Ronald DM, Neal HC, Lars IE, Lee AF, et al. Anesthesia for Obstetrics. In: Miller’s Anesthesia. ed 8. Philadephia: Elsevier Saunders, 2015:2329–30.

Anusorntanawat Ratikorn. A Comparison of Phenylephrine Administration between Intravenous Bolus and Slow Injection in Treatment of Spinal Anesthesia-Induced Hypotension on Bradycardia and Other Side Effects in Patients Undergoing Cesarean Section: A Randomized, Single-Blind Study. Thai J Anesth, 2019;46(2):80-7.

Lee HM, Kim SH, Hwang BY, Yoo BW, Koh WU, Jang DM, et al. The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section. Int J Obstet Anesth, 2016;25:17-22.

Zwane S, Bishop D, Rodseth R. Hypotension during spinal anaesthesia for Caesarean section in a resource-limited setting: towards a consensus definition. South Afr J Anaesth Analg, 2019;25(1):1-5.

David HC, Brian TB, Linda SP. Hypertensive Disorders. In: Chestnut’s Obstetric Anesthesia. Fifth edition. Elsevier Saunders, 2014:825-6.

Ronald DM, Neal HC, Lars IE, Lee AF, Jeanine PW, William LY. Preoperative Evaluation. In: Miller’s Anesthesia. 8th ed. Philadephia: Elsevier Saunders, 2015.

Farzam K, Richards JR. Premature Ventricular Contraction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532991/ [cited 2022 Sep 17].

Mohammadsadegh sanie, Navid K, Hossein H, Mohamadreza S. severe bradycardia following spinal anesthesia. Pars Jahrom Univ Med Sci, 2015;13(3):15-9.

Chowdhury T, Schaller B. Key to Prevention of Bradycardia: Be Relax Postoperatively. Medicine (Baltimore), 2016;95(22):e3733.

Lobo DN, Stanga Z, Aloysius MM, Wicks C, Nunes QM, Ingram KL, et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med, 2010;38(2):464-70.

Rijs K, Mercier FJ, Lucas DN, Rossaint R, Klimek M, Heesen M. Fluid loading therapy to prevent spinal hypotension in women undergoing elective caesarean section: Network meta-analysis, trial sequential analysis and meta-regression. Eur J Anaesthesiol, 2020;37(12):1126-42.

Alimian M, Mohseni M, Safaeian R, Faiz SHR, Majedi MA. Comparison of Hydroxyethyl Starch 6% and Crystalloids for Preloading in Elective Caesarean Section Under Spinal Anesthesia. Med Arch, 2014;68(4):279-81.

Arora P, Singh RM, Kundra S, Gautam PL. Fluid Administration Before Caesarean Delivery: Does Type and Timing Matter? J Clin Diagn Res JCDR, 2015;9(6):UC01-4.

Grocott MPW, Mythen MG, Gan TJ. Perioperative Fluid Management and Clinical Outcomes in Adults. Anesth Analg, 2005;100(4):1093-106.

Ngan Kee WD, Khaw KS, Lee BB, Ng FF, Wong MM. Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section. Br J Anaesth, 2001;87(5):772-4.

de Jonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med, 2001;29(6):1261-7.

Turker G, Yilmazlar T, Mogol EB, Gurbet A, Dizman S, Gunay H. The effects of colloid pre-loading on thromboelastography prior to caesarean delivery: hydroxyethyl starch 130/0.4 versus succinylated gelatine. J Int Med Res, 2011;39(1):143-9.

Mutter TC, Ruth CA, Dart AB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev, 2013;(7):CD007594.

Saw MM, Chandler B, Ho KM. Benefits and Risks of Using Gelatin Solution as a Plasma Expander for Perioperative and Critically Ill Patients: A Meta-Analysis. Anaesth Intensive Care, 2012;40(1):17-32.

Guo R, Xue Q, Qian Y, Hu Y, Tan J. The Effects of Ephedrine and Phenylephrine on Placental Vascular Resistance During Cesarean Section Under Epidual Anesthesia. Cell Biochem Biophys, 2015;73(3):687-93.

Jaitawat SS, Partani S, Sharma V, Johri K, Gupta S. Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study. J Obstet Anaesth Crit Care, 2019;9(2):81.

Tanaka M, Balki M, Parkes RK, Carvalho JCA. ED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery. Int J Obstet Anesth, 2009;18(2):125-30.

กิตติยา วิจิตรมาลา, สุชาดา ป้องขวาเลา, กฤษณา พิมพลีชัย. การเปรียบเทียบประสิทธิผลการให้ยาอีเฟดรีนรูปแบบฉีดเข้าหลอดเลือดดำร่วมกับการให้ สารน้ำกับการให้สารน้ำอย่างเดียวในการป้องกันการเกิดภาวะความดันโลหิตต่ำจากการ ให้ยาชาทางช่องน้ำไขสันหลังในหญิงตั้งครรภ์ที่เข้ารับการผ่าตัดคลอดแบบนัดหมาย. วารสารโรงพยาบาลมหาสารคาม, 2563;17(3):33-44.

Loubert C, Gagnon PO, Fernando R. Minimum effective fluid volume of colloid to prevent hypotension during caesarean section under spinal anesthesia using a prophylactic phenylephrine infusion: An up-down sequential allocation study. J Clin Anesth, 2017;36:194-200.

Gong RS, Liu XW, Li WX, Zhao J. Effects of colloid preload on the incidence of hypotension in spinal anesthesia for cesarean section: a systematic review and meta-analysis. Chin Med J (Engl), 2021;134(9):1043-51.