Preventing Spinal-induced Hypotension During Elective Cesarean Sections

The purpose of this quality improvement project was to implement an evidence-based intraoperative protocol to reduce the incidence of spinal-induced hypotension during elective cesarean sections.

A quality improvement project.

After receiving education, anesthesia providers implemented the intraoperative protocol for 6 weeks on elective cesarean sections. Intraoperative anesthesia records were retrospectively reviewed and evaluated preimplementation and postimplementation to determine the impact of the project on the incidence of spinal-induced hypotension.

The final sample included 134 patient charts (64 preimplementation and 72 postimplementation). The incidence of hypotension 10 minutes after spinal placement was not significantly different before (n = 9) or after implementation (n = 13; χ² = 0.4, P = .554). After project implementation, the rate of hypotension was 22% (n = 13) in patients not treated per the protocol and 0% (n = 0, χ² = 3.5, P = .062) in patients treated per the protocol. There was a 39.4% (P < .001) reduction in the need for rescue doses of phenylephrine and a 27.8% (P = .001) reduction in the need for rescue doses of ephedrine after protocol implementation.

Hypotension was not significantly decreased for all patients after project implementation but was eliminated for patients in whom the protocol was used. Provider utilization of the intraoperative protocol was only 18%. It is recommended to pursue additional interventions to increase protocol utilization, accessibility of protocol components, and staff training. Future studies can investigate the impact of this protocol on maternal nausea and vomiting incidence during elective cesarean sections.