African Health Sciences
Makerere University Medical School
Vol. 20, No. 4, 2020, pp. 1918-1926
Bioline Code: hs20156
Full paper language: English
Document type: Research Article
Document available free of charge
African Health Sciences, Vol. 20, No. 4, 2020, pp. 1918-1926
© Copyright 2020 - Ismail S et al.
Management of spinal-induced hypotension for elective caesarean section: A survey of practices among anesthesiologists from a developing country|
Ismail, Samina; Sohaib, Muhammad & Farrukh, Fatima
Background: In developing countries, more than half of the anesthesia-related maternal deaths are related to spinal hypotension.
Objective: To explore the practices of management of spinal induced hypotension with respect to fluid and vasopressor
administration among anesthesiologists from a developing country.
Methods: After approval from institutional ethics committee, an online questionnaire was sent to anesthesiologists registered
with Pakistan Society of Anesthesiologists between July and August 2018 to determine management strategies for
prevention and treatment of spinal-induced hypotension.
Results: The response rate was 36% (156/433), majority from academic institution (62.8%) with equal representation
from attending and trainee anesthesiologist. For prophylaxis 39.1% respondents did not use vasopressors, 32.7% used fluid
preloading with crystalloids (54.7%) as fluid of choice followed by combination of co-loading and vasopressor(22.4%).
Phenylephrine was the vasopressor of choice for both prophylaxis (33.1%) and treatment (57%). Attending anesthesiologist
used a combination of fluid co-loading and vasopressors for prophylaxis as compared to trainee anesthesiologists (37.2%
vs. 17.9%; P=0.035) and selected vasopressors according to patient’s heart rate (33.3% vs. 19.5%; p=0.05). Prophylactic
phenylephrine was used more by respondents from the academic institution (p=0.023). Fluid co-loading was used more by
respondents with <30 % compared to those with > 30% of clinical responsibility to obstetric anesthesia (P<0.05).
Conclusion: Phenylephrine as the vasopressor of choice indicates growing awareness of management strategies among
anesthesiologists from developing countries but there is a need to increase its use for prophylaxis. Some variation in practice
according to the level of anesthesiologist, practice type and responsibilities to obstetric anesthesia are evident.
Spinal anesthesia; Hypotension; Cesarean delivery; Vasopressors.