Effects of Sedation on Spinal Anesthesia-induced Maternal Hypotension
Condition: Cesarean Section; Preoperative Anxiety; Spinal Anesthesia; Sedation; Maternal Hypotension
MeSH terms: Hypotension
Study type: Observational

Summary: 
      Background: This study was designed to investigate the effect of sedation on the occurrence
      of maternal hypotension in preoperatively anxious parturients undergoing urgent category-1
      Cesarean section (C/S) under spinal anesthesia.

      Methods: After institutional ethics committee approval, prospectively collected data of 1824
      parturients undergoing C/S were reviewed. Parturients with high preoperative anxiety scores
      (visual analogue scale for anxiety (VAS-A)≥70) undergoing C/S under spinal anesthesia with
      thiopental (Group S=49) and without any other type of sedation (Group NS=53) were included in
      the analysis. Hemodynamic parameters were documented and maximum systolic arterial pressure
      (SAP) reductions from the baseline after spinal anesthesia were calculated. Incidences of
      hypotension (SAP≥30% decrease from baseline or <100 mmHg) and bradycardia (HR<55 beats/min),
      and related-ephedrine and -atropine requirements were noted. Our primary endpoint was to
      compare the maximum SAP reductions from the baseline values in Groups S and NS. Secondary
      endpoints were incidences of hypotension and bradycardia, required ephedrine and atropine
      doses, newborn Apgar scores at 1st and 5th min.
    

Detailed description: 
      Background: This study was designed to investigate the effect of thiopental sodium sedation
      on the occurrence of maternal hypotension in preoperatively anxious parturients undergoing
      urgent category-1 Cesarean section (C/S) under spinal anesthesia.

      Methods: After institutional ethics committee approval, prospectively collected data of 1824
      parturients undergoing C/S at Van Training and Research Hospital between August 2014 and
      February 2015 were reviewed. Parturients with high preoperative anxiety scores (visual
      analogue scale for anxiety (VAS-A)≥70) undergoing C/S under spinal anesthesia with thiopental
      (Group S=49) and without any other type of sedation (Group NS=53) were included in the
      analysis. All parturients received SA with hyperbaric bupivacaine 0.5% 2.5 mL. Hemodynamic
      parameters were documented and maximum systolic arterial pressure (SAP) reductions from the
      baseline after spinal anesthesia were calculated. Incidences of hypotension (SAP≥30% decrease
      from baseline or <100 mmHg) and bradycardia (HR<55 beats/min), and related-ephedrine and
      -atropine requirements were noted. All data were obtained from the surgical database and
      patient charts. Primary endpoint of our study was to compare the maximum SAP reductions from
      the baseline values in Groups S and NS. Secondary endpoints were incidences of hypotension
      and bradycardia, required ephedrine and atropine doses, newborn Apgar scores at 1st and 5th
      min.
    

Intervention name(s): Sedation; No sedation
Intervention type(s): Drug; Drug
Intervention description(s): Parturients who received IV thiopental 2 mg kg-1 and if necessary additional 50 mg immediately after spinal anesthesia until reaching at least Ramsay sedation score of 3 (1: patient anxious, agitated or restless, 6: patient with no response to light glabella tap or loud auditory stimulus.).; Parturients did not receive any type of sedation after spinal anesthesia.
Other intervention name(s): Thiopental; No drug
Intervention MeSH terms: Thiopental
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Parturients undergoing urgent category-1 Cesarean section (C/S) under spinal anesthesia