Recipes for obstetric spinal hypotension: The clinical context counts

Bishop, David G.; Rodseth, Reitze; Dyer, Robert A.

doi:10.7196/samj.2016.v106i9.10877

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…Hospital environments may be classified as either resource rich, resource constrained, where facilities are present although potentially overloaded, or resource poor. In the latter, there are differences in anaesthetic staffing, availability of drugs, monitoring and syringe pumps, and operating theatre and recovery facilities; patients may also present late, as a result of inadequate antenatal care, with hypovolaemia, electrolyte disturbances and undiagnosed underlying pathology .…”

Section: Special Circumstancesmentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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Why was this consensus statement developed?Advances in clinical practice are sometimes inhibited by a multitude of different options that need to be selected. There has been significant variation in the treatment of spinal anaesthesia-induced hypotension. These guidelines are designed to provide clinicians with specific best-practice plans that will cover a wide range of drug and equipment availability. Detailed recommendations are provided for the management of hypotension in resource-rich and resource-poor environments.

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Section: Special Circumstancesmentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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“…Definitions and treatment also need to be sensitive to the context in which they occur. 7 This study aimed to determine the incidence of hypotension for obstetric spinal anaesthesia when using current national intraoperative blood pressure management recommendations in a resource-limited setting and to use these incidences in conjunction with the relevant literature to propose a definition for use in a South African context.…”

Section: Introductionmentioning

confidence: 99%

Hypotension during spinal anaesthesia for Caesarean section in a resource-limited setting: towards a consensus definition

Zwane

Bishop

Rodseth

2018

Southern African Journal of Anaesthesia and Analgesia

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Background: Intraoperative hypotension following spinal anaesthesia for Caesarean section is associated with maternal morbidity and mortality. Because of inconsistent definitions the reported incidence of hypotension varies between 7% and 74%, making it almost impossible to set standard targets. Developing and adopting a clinically significant threshold for intraoperative hypotension will allow for benchmarking, comparison between studies, and consistency in guidelines and recommendations. Methods: Common definitions for spinal hypotension were first identified from a recent systematic review of the literature and a consensus statement on spinal hypotension. These definitions were applied to haemodynamic data taken from a prospective interventional obstetric spinal hypotension study conducted at Edendale Hospital, to determine the incidence of hypotension when applying these different thresholds. Finally, a definition was proposed based on these incidences and a review of the relevant literature. Results: Fifteen different definitions were identified. These were then applied to the study population with a resultant incidence of hypotension ranging from 15.8% to 91.4%. Based on a literature review of obstetric and other relevant perioperative and critical care medicine, targeting a mean arterial pressure > 70 mmHg and systolic blood pressure > 100 mmHg is recommended, and it is proposed that the lowest absolute values at which vasopressor therapy should be initiated are a mean arterial blood pressure < 65 mmHg or systolic blood pressure < 90 mmHg. Optimally, practitioners should maintain systolic blood pressure at greater than 90% of the baseline pre-spinal anaesthesia value. Conclusion: This study confirmed a wide variation in the incidence of obstetric spinal hypotension in a South African setting, depending on the definition used. An absolute threshold for intervention with vasopressor and an optimal target relative to baseline blood pressure are suggested. Further work is required to establish the effect of the adherence to these recommendations on important maternal and foetal outcomes.

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“…Titrated phenylephrine infusions require both appropriate syringe drivers, as well as skilled anaesthetists trained to adjust the rate of infusion in response to maternal haemodynamic changes. In resource‐limited settings, these elements may be unavailable, and simpler methods of administration are desirable . The consensus statement suggested alternative approaches for resource‐limited environments.…”

Section: Discussionmentioning

confidence: 99%

“…This statement is based on expert opinion, and has not yet been tested in clinical practice. Studies are required evaluating methods for the reliable administration of phenylephrine in resource‐limited settings . This study aimed to compare intermittent phenylephrine boluses with prophylactic combined phenylephrine and fluid co‐administration for the prevention of spinal hypotension in women undergoing elective caesarean section in a resource‐limited setting.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic phenylephrine and fluid co‐administration to reduce spinal hypotension during elective caesarean section in a resource‐limited setting: a prospective alternating intervention study

et al. 2019

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Summary Spinal hypotension is a common and clinically important problem during caesarean section. Current consensus recommendations for resource‐rich settings suggest the use of a titrated phenylephrine infusion, in combination with fluid coloading, for prevention of maternal hypotension. In resource‐limited settings, where syringe drivers are unavailable, these recommendations advise the addition of 500 μg phenylephrine to the first 1 l of intravenous fluid given after initiation of spinal anaesthesia, with additional vasopressor boluses as required. This prospective, alternating intervention study compared the use of a conventional phenylephrine rescue bolus strategy for prevention of hypotension, defined as systolic arterial pressure < 90 mmHg, with a phenylephrine infusion given according to the consensus recommendation. We studied 300 women having elective caesarean section. There were 77 (51%) women who developed hypotension in the bolus group vs. 55 (37%) in the phenylephrine infusion group (p = 0.011). This represented a 29% reduction in hypotension, with a number needed to treat of 6.8. The six highest systolic arterial pressure readings occurred in the phenylephrine infusion group (range 166–188 mmHg), and there were four instances of bradycardia (heart rate < 50 beats.min−1) with preserved systolic arterial pressure in each group. There were no adverse clinical sequelae, and no differences in neonatal Apgar scores in either group. The consensus recommendation for phenylephrine and fluid co‐administration in resource‐limited settings appears effective in preventing maternal hypotension, but at the cost of sporadic systolic hypertension.

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Recipes for obstetric spinal hypotension: The clinical context counts

Cited by 13 publications

References 22 publications

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

Hypotension during spinal anaesthesia for Caesarean section in a resource-limited setting: towards a consensus definition

Prophylactic phenylephrine and fluid co‐administration to reduce spinal hypotension during elective caesarean section in a resource‐limited setting: a prospective alternating intervention study

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