Incidence and associated factors for hypotension after spinal anesthesia during cesarean section at Gandhi Memorial Hospital Addis Ababa, Ethiopia

The ethical clearance was obtained from Ethical Review Committee Addis Ababa University, Ethiopia, Africa. A formal letter from Addis Ababa University was submitted to Gandhi memorial hospital. All clients who fulfilled the inclusion criteria were presented with the objectives and rationale for the study and were informed of their right to stop the interview at any time if they wish, without giving any reason. The interviewers discussed the issue of confidentiality and obtain verbal consent before the actual interview was launched.The Data were collected from selected study participants using a pretested questionnaire in order to maintain the quality and consistency of data. The questionnaire mainly addressed socio-demographic variables (age, BMI, ASA status, and baby weight), maternal variables(gravidity, indication for C/History of hypertension preoperative Hgb and heart rate), anesthetic and surgical variables (LA dose, preload, intraoperative fluids, time interval b/n spinal induction and skin incision, type of surgery (elective and emergency), estimated blood loss, surgeon and anesthetist experience, a dose of uterotonic drug used, any pre and intraoperative drugs used adjuvants used and sensory block height). The perioperative management was according to the established protocol of the institution: On arrival to operation theatre, all patients have an intravenous line placed and premedicated with IV cimetidine, metoclopramide, and ondasetrone 30 minutes before induction of anesthesia, for prevention of aspiration. Noninvasive monitoring consisted of non-invasive blood pressure (NIBP), electrocardiograph and pulse oximetry was used intraoperetively. The mean value of the first three consecutive measurements before commencing SA was defined as baseline blood pressure. Under strict aseptic precaution, SA was performed in sitting position by injection of a local anesthetic with or without opioid into the subarachnoid space. Immediately after the intrathecal injection, the patient was kept in supine left lateral tilt position. Sensory block height was measured by loss of cold sensation to alcohol swabs 10 min after induction of SA. After ensuring the appropriate level of blockade, surgery was started.