Maternal care bundle: The effect of a multimodal approach on the prevention of maternal hypotension following spinal anesthesia in parturients undergoing elective or urgent cesarean section

Background and Aim
Many techniques to prevent spinal induced hypotension in cesarean section have been advocated; but no one technique proved to be totally effective. The aim of this cohort interventional study was to investigate the efficacy of application of multimodal approach to decrease the incidence of hypotension (defined as mean arterial blood pressure ⩽60 mmHg) following spinal anesthesia in parturients undergoing elective or urgent cesarean section.
Patients and Methods
In this prospective cohort interventional study, 159 American Society of Anesthesiologists (ASA) classification I–II parturients undergoing elective or urgent cesarean section were enrolled. All patients received maternal care bundle which consisted of; fixed low dose of bupivacaine (7.5 mg + fentanyl 25 μg), coloading with 15 ml/kg lactated Ringer’s, placement of the patient in the supine wedged position, administration of 9 mg ephedrine sulphate IV after intrathecal injection and placement of graduated compression stockings (GCS) in the elevated leg position >45° and maintaining leg elevation at 20° following application of GCS. Demographic data, spinal anesthetic technique variables, fluid intake and urine output were documented. Mean arterial blood pressure, heart rate and oxygen saturation were recorded at baseline T0 (before spinal anesthesia administration), T1 (5 min following intrathecal injection of local anesthetics), T2 (15 min), T3 (30 min) and at T4 (end of procedure prior to PACU transfer). Total dose of ephedrine and any complication was documented.
Results
Incidence of hypotension after 5 min (T1) was 17.6%, at 15 min (T2) was 3.8% and at 30 min (T3) was 5%.
Conclusions
The application of a maternal care bundle had significantly decreased the incidence of spinal induced hypotension in parturient undergoing elective or urgent Cesarean delivery.