Original ArticleA survey of the management of spinal-induced hypotension for scheduled cesarean delivery
Introduction
Spinal-induced hypotension complicates up to 80% of spinal anesthetics administered for scheduled cesarean delivery.1 It may be associated with maternal dizziness, nausea and vomiting. Spinal-induced hypotension also leads to placental hypoperfusion with subsequent fetal hypoxia, acidosis and neurological injury.2 Several strategies for prevention and treatment have been described but there appears to be no consensus on which of these is most effective.2 Recent evidence suggests that phenylephrine is the vasopressor of choice for the management of spinal-induced hypotension at cesarean delivery.3, 4, 5, 6 Furthermore, it has been suggested that the administration of phenylephrine as a continuous infusion in combination with fluid co-loading may be the most effective method of prevention.4 A survey of anesthetic practice in the UK identified fluid preloading and ephedrine as the most common agents used for the prevention of spinal-induced hypotension.7 Subsequently, other approaches have been observed to be effective in the treatment and prevention, and have prompted changes in clinical practice.8
We therefore conducted a survey of the members of the Society for Obstetric Anesthesia and Perinatology (SOAP) to determine their current practices for treating and preventing spinal-induced hypotension associated with spinal anesthesia for scheduled cesarean delivery with respect to vasopressor use and fluid administration.
Section snippets
Methods
We developed a web-based survey questionnaire using ASP.NET and C#.NET programming language and tested an initial pilot version. The survey questions were initially developed by the four authors, two attending anesthesiologists (AH, HM) and two obstetric anesthesiology fellows (TA, RG), after reviewing recent publications on vasopressor and fluid therapy use in obstetric anesthesia. The questionnaire was initially distributed in a non-random, non-anonymous fashion to six other anesthesiologists
Results
We initially received 310 responses (184 to the first e-mail and an additional 126 to the second), which represented an overall response rate of 31%. However the responses from nurse anesthetists and anesthesiologists in training were significantly under-represented (18 of a possible 241 responses) and therefore excluded from further analysis. The remaining 292 responses represented a response rate of 39% (292/746). Ninety-two percent of the respondents were from North America, 57% were
Discussion
This survey highlights the different techniques being used for prevention and treatment of hypotension associated with spinal anesthesia in patients scheduled for cesarean delivery, as well as the significant variation in practice between anesthesiologists who practice in academic institutions compared with their colleagues in private practice, and between anesthesiologists with a greater clinical responsibility to obstetric anesthesiology, compared to those with <50% of their practice devoted
Acknowledgements
The authors would like to thank William D. White, MPH, for statistical assistance and Kenneth Childs, for developing the electronic form of the survey and setting up the database.
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Cited by (40)
Comparison of Continuous Infusion of Epinephrine and Phenylephrine on Hemodynamics During Spinal Anesthesia for Cesarean Delivery: A Randomized Controlled Trial
2020, Clinical TherapeuticsCitation Excerpt :Spinal anesthesia is a common technique for cesarean delivery, but it is usually accompanied with maternal hypotension.1–3
Optimal Management of Hypotension During Cesarean Delivery Under Spinal Anesthesia
2019, Advances in AnesthesiaCitation Excerpt :Definitions have included (1) SBP less than 90 mm Hg or less than 100 mm Hg, (2) SBP less than 80% of baseline, and (3) greater than a 25% decrease in SBP from baseline [26–30]. In practice, surveyed anesthesiologists use different SBP thresholds for vasopressor use, with most using a decrease in SBP greater than 20% [31]. This article does not specifically state the definition for hypotension used for each study discussed; however, it is important to note that such heterogeneity can confound study comparisons.
The extension of epidural blockade for emergency caesarean section: A survey of Scandinavian practice
2016, International Journal of Obstetric AnesthesiaCitation Excerpt :Ephedrine was the preferred vasopressor for transport even though phenylephrine is proposed as the first-line drug for spinal hypotension in parturients to avoid fetal acidosis.29 However, our data are analogous to USA data where clinicians prefer ephedrine over phenylephrine and are in accordance with Danish guidelines.9,28 Ninety per cent of Scandinavian specialists reported transport time to theatre to be <5 min, similar to UK findings.11
Update on volume therapy in obstetrics
2014, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :A ‘preload’ of fluid is given prior to initiating the spinal anaesthetic, and a ‘coload’ is given at the time of spinal injectate administration when cerebrospinal fluid is seen. In tandem with fluid loading, vasopressors such as phenylephrine are established as the first-line vasopressor for the treatment of maternal hypotension [12,17,19], but its discussion is beyond the scope of this article. The timing of fluid loading and the different types of available fluids (crystalloids and colloids) are discussed critically here.
A Comparison of Bolus Doses of Norepinephrine and Phenylephrine in the Treatment of Hypotension During Spinal Anaesthesia for Caesarean Section.
2023, Current Trends in Biotechnology and Pharmacy
This study was presented in part at the American Society of Anesthesiologists annual meeting, San Francisco, California, October 13–17, 2007.