PREVENTION OF HYPOTENSION IN CAESAREAN DELIVERY UNDER SPINAL ANAESTHESIA; THE COMBINATION OF MODIFIED SUPINE WEDGED POSITION, CRYSTALLOID CO�HYDRATION AND PROPHYLACTIC ATROPINE

Abstract

Objectives: To evaluate the efficacy of a modified supine wedged position with table tilt, crystalloid co hydration and prophylactic intravenous atropine in the prevention of hypotension in caesarean delivery under spinal anaesthesia.
Study Design: Phase 2 clinical trial.
Place and Duration of Study: PAF Hospital Masroor Karachi and PAF Hospital Rafiqi Shorkot Oct 2005 – April 2006.
Subjects and Methods: 40 parturients undergoing elective caesarean section under spinal anaesthesia were studied. Lactated Ringer's solution 10 ml/kg was administered over 10min.After Spinal in the sitting position with a 25-gauge Quincke needle using0.75% hyperbaric bupivacaine (12.75-15mg), the parturient was placed in the modified supine position with table tilt .Atropine 10μg/kg was given i/v. The baseline blood pressure and heart rate in each parturient before intervention (crystalloid co hydration, spinal, modified supine wedged position and i/v atropine) were taken as control and evaluated against the values after the intervention at different time intervals.
Results: Thirty nine out of forty patients completed the study. Mean upper sensory level was T4 at 6min post spinal. The mean spinal to delivery time was less than 12 min.5% of the parturients developed hypotension at 2 min post spinal. The mean heart rate was 96/min. The mean, systolic and diastolic blood pressures remained close to the base line values at 4, 6, 10, 12, 16 and 20 min post spinal. 
Conclusion: Modified supine wedged position with table tilt, crystalloid co-hydration and prophylactic i/v atropine is an effective combination technique which prevents spinal induced hypotension in caesarean delivery.