title: Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section.
abstract: BACKGROUND
  Hypotension or bradycardia after spinal anesthesia for cesarean section remain common and are serious complications. The current study evaluated factors associated to the incidences of hypotension or bradycardia in this context.
  
  
  METHODS
  A prospective cross sectional study from November 1, 2004 to July 31, 2005 was conducted on 722 parturients undergoing cesarean section under spinal anesthesia. T-test and Chi-square test were used in univariate analysis to compare continuous data and categorical data respectively. Multivariate logistic regression was performed on the variables hypotension (systolic pressure decrease > 30% of baseline value) and bradycardia (heart rate < 60 bpm) p-value < 0.05 was considered significant.
  
  
  RESULTS
  Incidence of hypotension and bradycardia were 52.6% and 2.5%. The probability of hypotension increased with estimated blood loss 500-1000 mL (odds ratio [OR] = 1.86; 95% CI 1.30-2.67, p = 0.001), estimated blood loss > 1000 mL (OR = 5.31; 95% CI 1.47-19.19, p = 0.011), and analgesia level > T4 (OR = 1.94; 95% CI 1.18-3.19, p = 0.009). Hypotension occurred despite left uterine displacement (OR = 1.56; 95% CI 1.11-2.19, p = 0.01). Risk factors associated with bradycardia were adding intrathecal morphine 0.2 mg (0.2 mL) (OR = 4.61; 95% CI 1.31-16.19, p = 0.017) to local anesthetics.
  
  
  CONCLUSIONS
  The present results indicated that the incidence of hypotension after spinal anesthesia for cesarean section increased with amount of estimated blood loss > 500 mL and analgesic level > T4. Adding intrathecal morphine 0.2 mg (0.2 mL) to local anesthetics increased incidence of bradycardia.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University Bangkok, Thailand.
authors.forename: Wanna
authors.initials: W
authors.lastname: Somboonviboon
authors.forename: Oranuch
authors.initials: O
authors.lastname: Kyokong
authors.forename: Somrat
authors.initials: S
authors.lastname: Charuluxananan
authors.forename: Arunchai
authors.initials: A
authors.lastname: Narasethakamol
mesh_terms: D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D015994:Incidence; D007278:Injections, Spinal; D016015:Logistic Models; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D019990:Perioperative Care; D011184:Postoperative Period; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D009020:Morphine