Journals / Akdeniz Tıp Dergisi / 2026 / Cilt: 12 Sayı: 1

Retrospectıve Evaluatıon Of Methods To Prevent Maternal Hypotensıon And Nausea In Caesarean Operatıons Usıng Spınal Anesthesıa

Spinal Anestezi Uygulanan Sezaryen Operasyonlarında Maternal Hipotansiyon Ve Bulantıyı Önleyecek Yöntemlerin Retrospektif Değerlendirilmesi

Sezen Özkaya(AKDENİZ ÜNİVERSİTESİ)0009-0001-0455-0291
Hakan Temel(AKDENİZ ÜNİVERSİTESİ)0000-0003-4135-2742
Bilge Karslı(Akdeniz Üniversitesi)0000-0003-4520-8844
Nurten Kayacan(AKDENİZ ÜNİVERSİTESİ)0000-0003-3542-4375
Pages
—
Publication Date
2026-04-16
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: We concluded that iv.granisetron given to prevent nausea and vomiting after spinal anesthesia decreased hypotension and bradycardia, provided hemodynamic stabilization, and reduced the use of ephedrine and adrenaline.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: We aimed to examine the causes of hypotension and nausea-vomiting that occur due to spinal anesthesia in cesarean section and to compare the effects of preventive and therapeutic methods on the mother-baby.
📊
Key Findings & Data:Method: ASA II, 348 patients who elective or emergency cesarean section with spinal anesthesia were included in the study.
💡
Conclusion & Impact:Conclusion: We concluded that iv.granisetron given to prevent nausea and vomiting after spinal anesthesia decreased hypotension and bradycardia, provided hemodynamic stabilization, and reduced the use of ephedrine and adrenaline.
🔬Design:Klinik Araştırma
📍Scope:Comprehensive Sample
⚙️Variables:Spinal anestezi · Hipotansiyon · Granisetron

Abstract

Objective: We aimed to examine the causes of hypotension and nausea-vomiting that occur due to spinal anesthesia in cesarean section and to compare the effects of preventive and therapeutic methods on the mother-baby. Method: ASA II, 348 patients who elective or emergency cesarean section with spinal anesthesia were included in the study. Systolic blood pressure(SBP), diastolic blood pressure(DBP), heart rate(HR), oxygen saturation(SpO2) were recorded before and after spinal anesthesia throughout the operation. Age, weight, height, medications, fluids, blood, operation time, Apgar scores are recorded on anesthesia forms. Anesthesia forms of cesarean section operations of patients were retrospectively evaluated in our study. Results: Changes in SBP, DBP and HR were compared in unmedicated, adrenaline, ephedrine and granisetron treated groups. SBP, DBP and HR were parallel and no statistically significant difference was found. SBP, DBP and HR decreased in all time periods after spinal anesthesia compared to baseline. It was observed that changes SBP in the unmedicated group were close to the baseline measurements compared to the other groups. In ephedrine-treated patients, it was observed that SBP decreased rapidly and significantly in the supine position and at the third minute, and approached the admission value at the twentieth minute. In the group administered adrenaline, the decrease in SDB was marked and remained below. In patients who were given granisetron, it was observed that SBP followed a parallel course with the patients who were not given any drug. There was no statistically significant difference between the groups in Apgar measurement. Conclusion: We concluded that iv.granisetron given to prevent nausea and vomiting after spinal anesthesia decreased hypotension and bradycardia, provided hemodynamic stabilization, and reduced the use of ephedrine and adrenaline.

Özet

Giriş: Sezaryen operasyonlarında spinal anestezi uygulamalarına bağlı ortaya çıkan hipotansiyon ve bulantı-kusmayı önleyici ve tedavi edici yöntemleri ve anne-bebek üzerinde etkilerini ve başarı oranlarını karşılaştırmayı amaçladık. Yöntem: Spinal anestezi altında elektif veya acil sezaryen ASA II, 348 hasta çalışmaya dahil edildi. Spinal anesteziden hemen önce ve spinal anesteziden sonra operasyon boyunca sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), kalp atım hızı (KAH), periferik oksijen satürasyonu (SpO2) ölçülerek kaydedilmektedir. Yaş, kilo, boy, kullanılan ilaçlar ve sıvılar, kan ve kan ürünleri, operasyon süresi, Apgar skorları anestezi hasta takip formlarına kaydedilmektedir. Retrospektif olarak, spinal anestezi yapılmış olan hastaların sezaryen operasyonlarının anestezi takip formları çalışmamızda değerlendirildi. Bulgular: SKB, DKB, KAH değişiklikleri ilaç verilmemiş, adrenalin, efedrin ve granisetron verilmiş olan hasta gruplarında karşılaştırıldı. SKB, DKB ve KAH değişiklikleri paralel seyretti ve istatistiksel anlamlı fark bulunmadı. Spinal anestezi sonrası SKB, DKB, KAH, giriş değerine göre tüm zaman dilimlerinde azalmıştır. SKB değişikliklerinin ilaç uygulanmayan grupta diğer gruplara göre giriş ölçümlerine yakın değerlerde olduğu görülmektedir. Efedrin verilmiş olan hastalarda supin pozisyonda ve üçüncü dakika’da SKB’nın hızlı ve belirgin bir şekilde düştüğü görülmüştür, yirminci dk'larda giriş değerine yaklaşmıştır. Adrenalin verilmiş olan grupta SKB‘da düşme belirgin olmuş ve giriş değerlerinin altında seyretmiştir. Granisetron verilmiş olan hastalarda SKB‘nın ilaç verilmemiş olan hastalarla paralel seyrettiği görülmüştür. Gruplar arasında Apgar ölçümlerinde istatistiksel olarak anlamlı bir fark bulunamamıştır. Sonuç: Spinal anestezi sonrası ortaya çıkan bulantı kusmayı önlemek için verilen i.v. granisetronun, hipotansiyon ve bradikardi gelişmesini azalttığını, hemodinamik stabilizasyon sağladığını, efedrin ve adrenalin kullanımını azalttığı sonucuna ulaştık.

🔖

Cite This Article

Özkaya, S., Temel, H., Karslı, B., Kayacan, N. (2026). Retrospectıve Evaluatıon Of Methods To Prevent Maternal Hypotensıon And Nausea In Caesarean Operatıons Usıng Spınal Anesthesıa. Akdeniz Tıp Dergisi, Cilt: 12 Sayı: 1. https://doi.org/10.53394/akd.1580992

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (67)

  1. Morgan GE, Mikhail MS, Murray MJ. Tulunay M, Cuhruk H (Çev.Ed). Klinik Anesteziyoloji. Ateş Y. Spinal Epidural Kaudal Bloklar. Dördüncü Baskı. Ankara. Güneş Kitabevi. 2008: 291.
  2. Erdem MK, Özgen S, Coşkun F. Obstetrik anestezi ve analjezi. Temel Kadın Hastalıkları ve Doğum Bilgisi. Kişnişçi H, Gökşin E (Eds.) Melisa Matbaacılık, Ankara. 1996; p: 173-86.
  3. Morgan GE, Mikhail MS, Murray MJ. Tulunay M, Cuhruk H (Çev.Ed). Klinik Anesteziyoloji. Batislam Y. Obstetrik Anestezi. Dördüncü Baskı. Ankara. Güneş Kitabevi. 2008: 890-20.
  4. Dourado AD, Filho RL, Fernandes RA, Gondim MC, Nogueira EV. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial. Brazilian Journal of Anesthesiology 2016;66(6):622-7.
  5. Langesaeter E, Rosseland LA, Stubhaug A. Continuous invasive blood pressure and cardiac output monitoring during cesarean delivery: a randomized, double-blind comparison of low-dose versus high-dose spinal anesthesia with intravenous phenylephrine or placebo infusion. Anesthesiology 2008;109(5):856-63.
  6. Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of Spinal AnesthesiaInduced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Metaregression. Anesthesia Analgesia 2016;123(4):977-88.
  7. Golfam P, Yari M, Bakhtiyari HR. Minimum appropriate dose of lidocaine with a fixed dose of sufentanil epinephrine used for spinal anesthesia in caesarian section. Anesthesiology and Pain Medicine 2013;2(3):123-6.
  8. Qiu MT, Lin FQ, Fu SK, Zhang HB, Li HH, Zhang LM, Li Q. Combination of low-dose bupivacaine and opioids provides satisfactory analgesia with less intraoperative hypotension for spinal anesthesia in cesarean section. CNS Neuroscience & Therapeutics 2012;18(5):426-32.
  9. De-Giorgio F, Grassi VM, Vetrugno G, d'Aloja E, Pascali VL, Arena V. Supine hypotensive syndrome as the probable cause of both maternal and fetal death. Journal of Forensic Sciences 2012;57(6):1646-9.
  10. Russell R, Popat M, Richards E, Burry J. Combined spinal epidural anaesthesia for caesarean section: a randomised comparison of Oxford, lateral and sitting positions. International Journal of Obstetric Anesthesia. 2002;11(3):190-5.
  11. Wang X, Xu JM, Zhou F, He L, Cui YL, Li ZJ. Maternal position and development of hypotension in patients undergoing cesarean section under combined spinal-epidural anesthesia of intrathecal hyperbaric ropivacaine. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research 2015;21:52-8.
  12. Lanni SM, Tillinghast J, Silver HM. Hemodynamic changes and baroreflex gain in the supine hypotensive syndrome. American Journal of Obstetrics and Gynecology 2002;187(6):1636-41.
  13. Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. British Journal of Anaesthesia 1996;76(1):61-5.
  14. Mendonca C, Griffiths J, Ateleanu B, Collis RE. Hypotension following combined spinal-epidural anaesthesia for Caesarean section. Left lateral position vs. tilted supine position. Anaesthesia 2003;58(5):428-31.
  15. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acidbase status: a meta-analysis. Anaesthesia 2005;60(7):636-53.
  16. Carvalho B, Collins J, Drover DR, Atkinson Ralls L, Riley ET. ED(50) and ED(95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology 2011;114(3):529-35.
  17. Harten JM, Boyne I, hannah P, varveris D, Brown A. Effects of a height and weight adjusted döşe of local anesthetic for spinal anesthesia for elective caserean section. Anaesthesia 2005;60:348-53.
  18. Ben-David B, Miller G, Gavriel R, Gurevitch A. Low-dose bupivacainefentanyl spinal anesthesia for cesarean delivery. Regional Anesthesia and Pain Medicine 2000;25(3):235-9.
  19. Choi DH, Ahn HJ, Kim MH. Bupivacaine-sparing effect of fentanyl in spinal anesthesia for cesarean delivery. Regional Anesthesia and Pain Medicine 2000;25(3):240-5.
  20. Norris MC. Patient variables and the subarachnoid spread of hyperbaric bupivacaine in the term parturient. Anesthesiology 1990;72(3):478-82.
  21. Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local and Regional Anesthesia 2017;10:83- 90.
  22. Sakata K, Yoshimura N, Tanabe K, Kito K, Nagase K, Iida H. Prediction of hypotension during spinal anesthesia for elective cesarean section by altered heart rate variability induced by postural change. International Journal of Obstetric Anesthesia 2017;29:34-8.
  23. Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. Anesthesiology 2003;98(2):530-47.
  24. Weigl W, Bierylo A, Wielgus M, Krzemien-Wiczynska S, Szymusik I, Kolacz M, Dabrowski MJ. Analgesic efficacy of intrathecal fentanyl during the period of highest analgesic demand after cesarean section: A randomized controlled study. Medicine 2016;95(24):3827.
  25. Greene N. The role of spinal anaesthesia in developing countries. Update in Anaesthesia 1993;3:1.
  26. American society of anesthesiologists task force on obstetric anesthesia: practice guidelines for obstetric anesthesia: An updated report by the american society of anesthesiologists task force on obstetric anesthesia. Anesthesiology 2016; 124:270–300.
  27. Bieniarz J, Crottogini JJ, Curuchet E, Barcia RC, Crottogini JJ. Aorto-caval compressionby the uterus in late human pregnancy. II. Anarteriographic study. Am J Obstet Gynecol 1968;100:203–17.
  28. Armstrong S, Fernando R, Columb M, Jones T. Cardiac index in term pregnant women in the sitting, lateral, and supine positions: an observational, crossover study. Anesth Analg 2011;113:318–22.
  29. Patel M, Samsoon G, Swami A, Morgan B. Posture and the spread of hyperbaric bupivacaine in parturients using the combined spinal epidural technique. Can J Anaesth 1993; 40: 943-6.
  30. Yun EM, Marx GF, Santos AC. The effects of maternal position during induction of combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 1998; 87: 614-8.
  31. Russell IF. Effect of posture during the induction of subarachnoid analgesia for caesarean section. Br J Anaesth 1987; 59:342-6.
  32. Inglis A, Daniel M, McGrady E. Maternal position during induction of spinal anaesthesia for Caesarean section A comparison of right lateral and sitting positions. Anaesthesia 1995; 50:363-5.
  33. Coppejans HC, Hendrickx E, Goosens J, Vercauteren MP. The sitting versus right lateral position during combined spinalepidural anesthesia for cesarean delivery: block characteristics and severity of hypotension. Anesth Analg 2006; 102: 243-7.
  34. Simon LB, et al: Effect of enjection rate on hypotantion associated with spinal anesthesia for ceserean section, International Journal of Obstetric Anesthesia, 2000; 9:10–14.
  35. Hartley H, Seed PT, Ashworth H. Effect of lateral versus supine wedged position on development of spinal blockade and hypotension, International Journal of Obstetric Anesthesia 2001;10:182–8.
  36. Sia AT, Fun WL, Tan TU. The ongoing challenges of regional and general anaesthesia in obstetrics. Best Practice & Research Clinical Obstetrics & Gynaecology 2010;24(3):303-12.
  37. Chung CJ, Bae KY, Chae YJ. Spinal anaesthesia with 0.25% hyperbaric bupivacaine for caesarean section: effect of volume. Br J Anaesth 1996; 77:145-9.
  38. Morgan P J, Halpern S H, Tarhis J. The Effects of an ıncrease of central blood volume before spinal anesthesia for ceserian delivery: Anesth Analg 2001;92:997-1005.
  39. Loughrey JP, Walsh F, Gardiner J. Prophylactic intravenous bolus ephedrine for elective caesarean section under spinal anaesthesia. Eur J Anaesthesiol 2002; 19:63-8.
  40. Dahlgren G, Granath FK, Pregner PG, Rosblad H. Irestedt and Wessel L. Colloid vs. crystalloid preloading to prevent maternal hypotension during spinal anesthesia for elective cesarean section, Acta Anaesthesiol Scand 2005; 49: 1200–6.
  41. Carpenter RL, Caolan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906-16.
  42. Cardoso, MM, Bliacheriene, S, Freitas, CR, Cesar, DS, Torres, ML. Preload during spinal anesthesia for cesarean section: comparison between crystalloid and colloid solutions. Rev Bras Anestesiol 2004;54(6):781-7.
  43. Ramin, SM, Ramin, KD, Cox, K, Magness, RR, Shearer, VE, Gant, NF. Comparison of prophylactic angiotensin II versus ephedrine infusion for prevention of maternal hypotension during spinal anesthesia. Am J Obstet Gynecol 1994;171(3):734-9.
  44. Rout CC, Rocke DA, Levin J, Gouws E, Reedy D: A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993; 79: 262-9.
  45. Rout CC, Akoojee SS, Rocke DA, Gouws E: Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth 1992; 68: 394-7.
  46. Koski E, Tuppurainen T, Mattila M, Gordin A, Salo H. Hydroxyethyl starches, dextran and balanced salt solution in correction of hypotension during epidural anaesthesia. Acta Anaesth Scandinavica 1984; 28(6):595-9.
  47. Bhagwanjee S, Rocke DA, Rout CC, Koovarjee RV, Brijball R. Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs. Br J Anaesth 1990; 65: 819-22.
  48. Somboonviboon W, Kyokong O, Charuluxananan S, Narasethakamol A. Incidence and risk factors of hypotension and bradycardia after spinal anesthesia for cesarean section. Medical journal of the Medical Association of Thailand 2008; 91(2): 181.
  49. Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective cesarean delivery: A meta-analysis. Can J Anesth 2010;57:24–31.
  50. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007;106(4):843-63.
  51. Dahlgren G, Granath F, Wessel H, Irestedt L. Prediction of hypotension during spinal anesthesia for cesarean section and its relation to the effect of crystalloid or colloid preload. International Journal of Obstetric Anesthesia 2007;16: 128-34.
  52. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006; 18:(4):2251.
  53. Mercier FJ. Cesarean delivery fluid management. Cur Opin Anaesthesiol 2012;25: 286–91.
  54. Teoh WHL, Westphal M, Kampmeier TG. Update on volume therapy in obstetrics, Best Pract Res Clin Anaesthesiol 2014; 28 (3):297–303.
  55. American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology. 2007;106(4):843-63.
  56. Hanss R, Bein B, Ledowski T, Lehmkuhl M, Ohnesorge H, Scherkl W, Steinfath M, Tonner PH. Heart rate variability predicts severe hypotension after spinal anesthesia for elective cesarean delivery. Anesthesiology 2005;102:1086-93.
  57. Tarkkila PJ, Kaukinen S. Complications during spinal anesthesia: a prospective study. Regional Anesthesia 1991;16(2):101-6.
  58. Lesser JB, Sanborn KV, Valskys R, Kuroda M. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. The Journal of the American Society of Anesthesiologists 2003; 99(4): 859-66.
  59. Hasanin A, Aiyad A, Critchley LAH, Fouad R, Osman M, Mokhtar A, Refaat S, Hasabelnaby Y. Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial. BMC Anesthesiology 2017; 17(1): 60.
  60. Lee SWY, Khaw KS, Kee WDN, Leung TY. Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women. British Journal of Anaesthesia 2012; 109(6): 950-6.
  61. Critchley L, Short T, Gin T. Hypotension during subarachnoid anaesthesia: haemodynamic analysis of three treatments. British Journal of Anaesthesia 1994; 72(2): 151-5.
  62. Singh K, Payal YS, Sharma JP, Nautiyal R. Evaluation of hemodynamic changes after leg wrapping in elective cesarean section under spinal anesthesia. Journal of Obstetric Anaesthesia and Critical Care 2014; 4(1): 23.
  63. Balki M, Carvalho CA. Intraoperative nausea and vomiting during ceserian section under spinal anesthesia. International Journal of Obstetric Anesth 2005;14,230-41.
  64. Martinek RM. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report. Canadian Journal of Anesthesia 2004; 51(3): 226-30.
  65. Aviado DM, Aviado DG. The Bezold‐Jarisch Reflex. Annals of the New York Academy of Sciences 2001; 940(1): 48-58.
  66. Morgan P J, Halpern S H, Tarhis J. The Effects of an ıncrease of central blood volume before spinal anesthesia for ceserian delivery: Anesth Analg 2001;92:997-1005.
  67. Gogarten W. Spinal anaesthesia for obstetrics. Best Pract Res Clin Anaesthesiol 2003; 17(3): 377-92.