Occurrence and duration of spinal-induced hypotension in caesarean section patients at an academic hospital

Abstract

Background Spinal anaesthesia is a common technique used worldwide for caesarean sections. A common, but potentially fatal, complication is hypotension. Annually approximately 4500 caesarean sections are done under spinal anaesthesia at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The aim of this study was to describe the occurrence and duration of SIH (spinal-induced hypotension) in ASA I and II patients presenting for caesarean section at a central academic hospital. Methods This was a retrospective, descriptive and contextual study of anaesthetic records of ASA I and II patients presenting for caesarean section under spinal anaesthesia during 2013. The data were collected using consecutive convenience sampling and were analysed using inferential and descriptive statistics. Results At CMJAH, 85% of patients presenting for caesarean section under spinal anaesthesia developed SIH. This included patients that had received vasopressors and fluid therapy for the prevention and management of SIH. Furthermore, 58% of these patients still had SIH upon discharge to the postnatal wards. There was a statistically significant change in MAP (mean arterial pressure) from baseline to discharge values. Conclusion The high number of patients that are discharged to the wards with SIH is concerning. The prevention and management interventions currently instituted for SIH are possibly inadequate. It is therefore recommended that the level of postoperative monitoring and management of SIH patients be improved upon and continued, until the effects of spinal anaesthesia have abated.