Comparasion of hemodynamic changes and vasopressor Requirements after spinal anesthesia in preeclamptic And non-preeclamptic parturients during cesarean sec- Tion in jimma zone public hospitals, southwestern ethio- Pia,2022: a prospective cohort study

Abstract

Background: The hemodynamic change is a common problem during cesarean section following spinal anesthesia/SA/. The choice of anesthesia in the preeclamptic case is the main concern as they are assumed at increased risk of hemodynamic changes. The hemodynamic changes compro- mise fetal and maternal well-being if not managed immediately. Objectives: To compare hemodynamic changes and vasopressor requirements after spinal anes- thesia in preeclamptic and non-preeclamptic parturients during cesarean section in Jimma zone public hospitals, Southwestern Ethiopia, from August 15- November 30, 2022. Methods: The facility-based prospective cohort study was conducted on 126 parturients. The study hospitals were selected by using simple random sampling and proportional sample sizes were allocated to the hospitals. The Consecutive sampling technique was used. Symmetric data were analyzed by an independent t-test, asymmetric data were analyzed by Mann-Whitney U-test, and a chi-square test was used for categorical data. Hypotension was defined as a 20% drop in SBP and HR changes were 20% (decrement or increment) of HR from the baseline value. The P- value <0.05 was considered statistically significant. Results: The incidence of hypotension after SA was higher in non-preeclamptic (50.8%) compared to preeclamptic (31.7%). The SBP, DBP, and MAP were significantly higher in the preeclamptic group thorough out intraoperative period (P<0.001). The maximum BP fall was significantly higher in the non-preeclamptic compared with the preeclamptic group. The baseline and intraoper- ative HR were comparable between the groups. The vasopressor requirements were significantly higher in the non-preeclamptic as compared to preeclamptic(P=0.046). The majority of non- preeclamptic developed hypotension within the first 15 minutes. However, the preeclamptic de- veloped hypotension after 15 minutes following SA. Conclusion and recommendation: The incidence of SA-induced hypotension, the magnitude of BP fall, and vasopressor requirements were less in the preeclamptic group. The intraoperative HR changes were comparable between the groups. The number of episodes of hypotension was higher in the non-preeclamptic. The use of spinal anesthesia in preeclamptic is safe regarding the in- traoperative hemodynamic changes for cesarean section if there are no other