Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study

Comparison of the hemodynamic changes between preeclamptic and normotensive parturients who underwent cesarean section under spinal anesthesia at North Showa zone public hospitals, Oromia region, Ethiopia, 2022: a prospective cohort study

BACKGROUND

Spinal anaesthesia complicates maternal hemodynamic and may expose the parturient to dangerous cardiovascular problems. Up to 7% to 89.2% of pregnant women can suffer from spinal anaesthesia-related hypotension. The aim of this study to compare the hemodynamic changes between preeclamptic and normotensive parturients who underwent caesarean section under spinal anaesthesia at North Showa Zone Public Hospitals, Oromia Region, from February 15 to May 15, 2022.

METHODS

A prospective cohort study was conducted on a total of 140 parturients (70 in each group) who underwent cesarean delivery under spinal anesthesia. The study participants were chosen using a consecutive sampling technique. Data were collected from patient charts and intraoperative observations and entered into the Epi Data software version 4.6 and exported to the Statistical Package for the Social Sciences version 25 software. Hemodynamic change = (baseline value-current value/baseline value) * 100. The independent t-test, Mann-Whitney U test, two ways mixed ANOVA, chi-square, and Fisher's exact test was used to analyze the data as appropriate. A P < 0.05 was statistically significant.

RESULTS

The mean percentage change in SBP, DBP, and MAP after spinal anaesthesia was a statistically significant difference between the normotensive and preeclamptic groups, except MAP at 15 min was comparable between the two groups with p = 0.638. The proportion of preeclamptic parturients who develop hypotension was 47%, compared to 74% of normotensive parturients, and the RR of developing hypotension, if participants were preeclamptic, was 0.63, with a 95% confidence interval of 0.412 to 0.978 and a p = 0.039. The mean change in heart rate during the first 15 min was comparable between the groups.

CONCLUSION

In contrast to normotensive parturients undergoing caesarean section under spinal anaesthesia, our study found that the hemodynamic change was lower in preeclamptic parturients. The proportion of preeclamptic women who develop hypotension was 47%, compared to 74% of normotensive parturients.

A Comparative Study of Hemodynamic Parameters Following Subarachnoid Block in Patients With and Without Hypertension

Background

Hypotension is common in patients receiving a subarachnoid block (SAB) and can decrease vital organ perfusion, causing increased morbidity and mortality. Patients may receive intraoperative intravenous (IV) fluids and rescue medications to avoid these adverse effects and maintain adequate hemodynamic parameters. We conducted this study to compare the hemodynamic parameters and heart rate following spinal anesthesia on patients receiving antihypertensive medications (e.g., calcium channel blockers with or without beta-blockers) with those without hypertension during surgical procedures requiring SAB.

Methods

We conducted this two-year, single-center, prospective observational study in patients with hypertension and blood pressure within reference ranges receiving elective surgical procedures that do not require a definitive airway. All participants were from the American Society of Anesthesiologists physical status I and II. We assigned patients into three groups. Group 1 consisted of patients with hypertension receiving calcium channel blockers. Group 2 consisted of patients with hypertension receiving calcium channel blockers with beta-blockers. Patients whose blood pressure was within reference range were assigned to group 3. We collected patient ages and body weights, and we compared heart rate (HR), systolic and diastolic blood pressure (SBP; DBP), and mean arterial pressure (MAP) between the groups. We also compared the use of intraoperative rescue medications, IV fluid administration, and patient outcomes. We used Epi Info version 7.1 (Atlanta, GA: Centers for Disease Control and Prevention) public domain software for statistical analysis.

Results

Seventy-eight patients were included in the study (41 men, 37 women); group 1, HR, SBP, DBP, and MAP significantly declined over time in all groups, but there were no significant differences when comparing parameters between groups. Hypotension occurred in significantly more patients in group 1 (p=0.02) than groups 2 and 3. Bradycardia was experienced by significantly more patients in group 2 (p<0.05) than group 1 and group 3. Twenty-four patients in group 3, 17 patients in group 1, and 14 patients in group 2 required IV fluid in the first 20 minutes of the procedure, and the differences between the groups were not significant. Likewise, 15 patients in group 3, 14 in group 1, and 10 in group 2 required ephedrine, but the differences were not significant.

Conclusions

We compared intraoperative hemodynamic parameters following spinal anesthesia on patients receiving antihypertensive medications with patients without hypertension following SAB. Our results showed no meaningful differences in hemodynamic parameters between patients receiving antihypertensive drugs (calcium channel blockers without or in combination with beta-blockers) and those not receiving antihypertensive drugs after SAB. Therefore, calcium channel blockers alone or in combination with beta-blockers can be used to control patient blood pressure prior to surgery.