By

Dr.K.SELVI D.A POST GRADUATEDr.K.SELVI D.A POST GRADUATE

Co-authorsCo-authors

Prof.Dr.R.SELVAKUMARProf.Dr.R.SELVAKUMAR

Prof Dr.B.CHANDRIKAProf Dr.B.CHANDRIKA

Prof Dr.A.CHANDRASEKARProf Dr.A.CHANDRASEKAR

COIMBATORE MEDICAL COLLEGECOIMBATORE MEDICAL COLLEGE

The correlation between the spread of local anesthesia in the sub-arachnoid space and hemodynamic changes has always been unpredictable and factors responsible for it are being under debate.

This is more frequently experienced in spinal anesthesia for caesarian section.

To asses the level of analgesia and its To asses the level of analgesia and its degree of correlation with the degree of correlation with the hypotension and other side effects hypotension and other side effects using standard spinal anaesthetic using standard spinal anaesthetic dosage in caesarean section.dosage in caesarean section.

To asses the degree of correlation of To asses the degree of correlation of weight, height,BMI with hypotension.weight, height,BMI with hypotension.

A sample of 50 patients who underwent Caesarean section (elective & emergency)

1.8 ml 0.5% of Bupivacaine in L3-L4 space with table positioned horizontally, patient lying in Rt lateral position ,then patient was placed in supine position with a wedge under the right hip.

Fall of more than 20% of systolic BP from the base line value was considered as hypotension and managed with inj.ephedrine in incremental dosage( 6mg )

Parameters likeParameters likePulsePulseBPBPSpo2Spo2Level of blockLevel of blockSide effectsSide effectsTime to reach maximum segmentTime to reach maximum segment &&Demographic details likeDemographic details likeHeightHeightWeightWeightBMIBMI

Maximum level of block Two segment regression time Level at the end of one hour Time to reach maximum segment

Maximum level of block

Time to reach maximum segment (minutes)

Level at the end of one hour

Two segment regression time (minutes)

T4 4 ± 2 T5 ± 1 80 ± 16

Percentage of inj.ephedrine usage

Nil usage < 6mg >6mg

38% 30% 32%

Side effects

1.Restlessness2.vomiting

Restlessness Vomiting

12% 44%

COMPARISON BETWEEN STABLE AND HYPOTENSIVE PATIENTS

Sample %

Weight (Kgs)

Height (cms)

BMITime to reach maximum segment(minutes)

Stable patients

38 65.4

157 25.17 6

Patients with hypotension

62 56 147 25.4 4

CORRELATION WITH LEVEL OF SPINAL BLOCK

Level of block

No. of patients

Nil ephedrine usage

>6mg ephedrine usage

T4 24(48%) 3(12.5%) 21(87.5%)

T5 15(30%) 6(40%) 9(60%)

T6 11(22%) 8(72.7%) 3(27.2%)

Restlessness

There is no positive correlation of restlessness with hypotension

SIDE EFFECTS

No of patients who developed restlessness

Inj.ephedrine used

6 (12%) 3(6%)

Vomiting

There is positive correlation of vomiting with hypotension.

No of patients who developed vomiting

Inj.ephedrine used

22(44%) 16(32%)

So by giving 1.8 ml 0.5% of Bupivacaine in L3-L4,space with table positioned horizontally,

patient was placed in supine position with a

wedge under the hip.

Incidence of hypotension -62% Incidence of restlessness-12% Incidence of vomiting-44%

• As level of block increases severity of hypotension increases.

• There is positive correlation of weight,height & BMI with

hypotension.

• There is a positive correlation between vomiting and hypotension.

SUMMARY

According to my study level of block significantly decides the degree of hypotension.

Height ,weight,BMI & time to reach maximum segment are also the important co-factors in deciding the incidence of hypotension.