Background And Justification: Spinal Anaesthesia is widely regarded as a reasonable anaesthetic option for caesarean delivery, provided there is no contraindication. Pregnancy causes major physiological changes to the mother’s body. An understanding of the physiological changes in pregnancy is the key to safe obstetric anaesthesia. Spinal Anaesthesia is associated with hypotension which can have maternal and foetal side effects. Methods: This study was performed on 100 patients, after getting informed consent. In this study the baseline hemodynamic parameters of the patient was noted during intra operative period. After spinal anaesthesia is performed by the Anaesthesiologist, hemodynamics such as Heart Rate, Blood Pressure, Mean Arterial Pressure and SPO2 was noted for every 3 minutes for first 20 minutes after which it was noted for every 5 minutes, till end of the surgery. Results: From the descriptive statistics and chi square test, after spinal anaesthesia performed there is a hypotension, p=0 which is <0.05, hence statistically significant, and there is fall in heart in rate, p=0.0029 which is <0.05, hence statistically significant. Conclusion: 100 pregnant patients who underwent spinal anaesthesia for elective caesarean section were included in this study. Based on the result we concluded that hypotension and bradycardia are the frequent response after spinal anaesthesia due to arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardio inhibitory receptors. This study benefits to the anaesthesiologist in prediction of possible adverse effects and to overcome the same.
When medically necessary, a caesarean section can be a life-saving procedure [1]. Caesarean sections can be either emergency, urgent, or elective [3]. As a result, regional anesthesia has become the anaesthetic method of choice for many anaesthesiologists doing elective procedures [5]. Spinal anestheisa is performed by injecting small doses of local anaesthetic are injected into the Sub arachnoid space.Often performed at level of L3-L4. Surgery below the umbilicus may be performed under spinal anaesthesia, which is simple to administer and has the potential to offer good operating conditions. [7]
Hemodynamic Monitoring:
Hemodynamic monitoring is a crucial aspect of the cardiovascular patient's perioperative therapy. It aids in the detection of hemodynamic changes, the diagnosis of their underlying causes, and the optimization of oxygen delivery to tissues. Additionally, hemodynamic monitoring is required to assess the efficacy of therapeutic measures such as volume expansion or vasoactive medicines. [9]
The purpose of hemodynamic monitoring is to keep tissue perfusion adequate. [10] The fundamental hemodynamic condition is determined by monitoring heart rate (HR) and mean blood pressure (BP) as a surrogate for tissue perfusion. When these qualities vary rapidly, a single measurement provides insufficient information, hence continuous measurement is preferred. Noninvasive and continuous blood pressure monitoring, on the other hand, has several advantages, especially when intra-arterial blood pressure measurement is not suggested and intermittent readings lack the required time resolution. [11]
Study design : Observational study
Sample Size : A total of 100 patients belonging to ASA-II and ASA-III (American Society of Anesthesiologists) were enrolled in the study.
Subject Selection : Maternal woman who underwent for elective cesaerean section under spinal anaesthesia
INCLUSION CRITERIA
EXCLUSION CRITERIA
STUDY PROCEDURE:
After the ethical clearance obtained from human ethics committee, the study was conducted on the Department of Anaesthesiology CHRI. This study was performed on 100 patients, after getting the informed consent.
Patient was explained about the procedure well in advance. In sitting position, Subarachanoid block will be performed under sterile aseptic precautions using 25G or 26G quincke needle in L3-L4 space. Once CSF can be aspirated, which confirms the needle is at subarachnoid space, Local anesthetic will be given. Then the patient is made to lie down supine. Motor and sensory blockade will be noted. Sensory Level was evaluated by loss of sensation to cold using a cold ice pack and pin prick sensation and Motor block assessed by modified bromage scale.
In this study, the baseline hemodynamic parameters of the patient was noted during intra operative period. After performing spinal anaesthesia, hemodynamics such as Heart Rate, Blood Pressure, Mean Arterial Pressure and SPO2 was noted for every 3 minutes for first 20 minutes after which it was noted for every 5 minutes, till end of the surgery.
STATISTICAL METHOD:
This study was analysed by an descriptive statistics, frequency and chi square test. The study was conducted after obtaining approval by the Institutional Human Ethical Committee. Informed consent was obtained from the patients who participate in the study. The collected data have been kept confidential.
Among the study population, we calculated the percentage of age distribution and was found that age group between 26-30 years (45%) had the highest number of study sample and the minimum was in between 40-45 years (1%) and found to be insignificant p >0.005
AGE GROUP |
FREQUENCY |
PERCENTAGE |
18-25 |
30 |
30% |
26-30 |
45 |
45% |
31-35 |
16 |
16% |
35-40 |
8 |
8% |
40-45 |
1 |
1% |
Tabel 1: Age Distribution In Study Population
Among the study population, patients who belong to ASA-PS II were found to be 92%. Only 8% of the study population were categorised under ASA III and is not significant p>0.005
Table 2: Asa Distribution In Study Population
ASA |
FREQUENCY |
PERCENTAGE |
II |
92 |
92% |
III |
8 |
8% |
Baseline Heart rate was recorded for all the study population. None of the patients had baseline value <60/min. Around 76% had Heart rate around 60-100/min and 24% had Heart rate of >100/min
Table 3 : Baseline Heart Rate In Study Population
BASELINE-HR |
FREQUENCY |
PERCENTAGE |
<60 |
0 |
0% |
60-100 |
76 |
76% |
>100 |
24 |
24% |
GRAPH 1 : Baseline Heart Rate in study population
Baseline Blood pressure was recorded for all the study population. None of the patients had MAP <60. In 95% of the study population, MAP was around 60-100 and in 5% had MAP >100
Table 4 : Baseline Map In Study Population
BASELINE-MAP |
FREQUENCY |
PERCENTAGE |
MAP <60 |
0 |
0% |
MAP 60-100 |
95 |
95% |
MAP >100 |
5 |
5% |
GRAPH 2 : Baseline MAP in study population
Table 5: Baseline-Spo2 In Study Population
BASELINE-SPO2 |
FREQUENCY |
PERCENTAGE |
<100 |
54 |
54% |
~100 |
46 |
46% |
Table 6 : Baseline Respiratory Rate In Study Population
BASELINE-RR |
FREQUENCY |
PERCENTAGE |
<12 |
8 |
8% |
12-18 |
39 |
39% |
>18 |
53 |
53% |
Table 7: After Spinal Heart Rate In Study Population
AFTER SPINAL-HR |
FREQUENCY |
PERCENTAGE |
<60 |
0 |
0% |
60-100 |
75 |
75% |
>100 |
25 |
25% |
Graph 3 : After Spinal Heart Rate In Study Population
Table 8: After Spinal Bp In Study Population
AFTER SPINAL-BP |
FREQUENCY |
PERCENTAGE |
MAP <60 |
2 |
2% |
MAP 60-100 |
96 |
96% |
MAP >100 |
2 |
2% |
Graph 4 : After Spinal Bp In Study Population
Table 9: Cross Tabulation Between Baseline-Hr And After Spinal-Hr Parturients Underwent Between 21min
HEART RATE |
<60 |
60-100 |
>100 |
TOTAL |
BASELINE |
0 |
76 |
24 |
100 |
AFTER SPINAL-HR BETWEEN 21MIN |
9 |
77 |
14 |
100 |
TOTAL |
9 |
153 |
38 |
200 |
|
VALUE |
Df |
P |
X2 |
11.636 |
2 |
0.0029 |
N |
100 |
|
|
P=0.0029 which is <0.05 statistically significant. Hence, null hypothesis is rejected. So there is an evidence of significant fall in heart rate
TABLE 10: Chi-Square Test Between Baseline-BP And After Spinal-BP
BP |
MAP <60 |
MAP 60-100 |
MAP >100 |
TOTAL |
BASELINE |
0 |
95 |
5 |
100 |
AFTER SPINAL-BP BETWEEN 21MIN |
25 |
75 |
0 |
100 |
TOTAL |
25 |
170 |
5 |
200 |
|
VALUE |
Df |
P |
X2 |
32.352 |
2 |
0 |
N |
100 |
|
|
P=0 which is <0.05 statistically significant. Hence, null hypothesis is rejected. So there is an evidence of significant fall in Blood Pressure
This study is based on assessing the hemodynamic changes after spinal anaesthesia in 100 pregnant patients underwent elective lower caesarean section. The result is based on the Descriptive statistics and Frequency. There are 30% people from 18-25 age group, 45% people from 26-30 age group,16% people from 31-35 age group,8% from 35-40 age group and 1% from 40-45 were participated in this study. There are 92% patients under ASA-II and 8% were under ASA-III. After the patient shifted into the OT, patient’s Baseline HR, SPO2, RR, SBP, DBP and MAP were monitored. After spinal anaesthesia performed, hemodynamics will be noted for 3min for first 21min and then noted for after 5min till the end of surgery. From the descriptive statistics and chi square test, after spinal anaesthesia performed there is a hypotension, p=0 which is <0.05, hence statistically significant, and there is fall in heart in rate, p=0.0029 which is <0.05, hence statistically significant.
The most common complication related to maternal morbidity and mortality during Caesarean section was hypotension following spinal anaesthesia.[12] The reported incidence of hypotension after spinal anaesthesia in Caesarean section varies between 7 and 89.2% due to conflicting definitions.[13]
In a study by Tikuneh Yetneberk Alemayehu et al. [12] on 122 pregnant patients (81 non preeclamptic and 41 preeclamptic parturients) based on age, weight, height, the volume of 0.5% plain bupivacaine, and speed of spinal administration between groups and based on result he concluded that Preeclamptic parturients had spinal anaesthesia-induced hypotension less frequently and to a lesser than non-preeclamptic parturients during caesarean delivery.
In a study by Anestezjologia I Ratownictwo et al. [10] on 195 pregnant patients based on Haemodynamic data SBP, DBP, MAP, heart rate and oxygen saturation and based on result, he concluded that the incidence of arterial hypotension, the need for ephedrine and phenylephrine, or the haemodynamic profile as compared to lateral decubitus position are unaffected by spinal anaesthesia delivered in the sitting position with hyperbaric bupivacaine and fentanyl.
100 pregnant patients underwent spinal anesthesia for elective caesarean section were included in this study. Based on the result we concluded that the hypotension and bradycardia are the frequent response after spinal anesthesia due to arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardio inhibitory receptors. This study benefits to the anesthesiologist in prediction of possible adverse effects and to overcome the same.