Blood pressure management for caesarean delivery under spinal anaesthesia: a UK multi-centre audit (2023)

Background

Untreated sympathetic blockade after spinal anaesthesia for caesarean delivery can cause profound maternal hypotension. National Institute for Health and Care Excellence (NICE) guidance recommends systolic blood pressure (SBP) should be maintained ≥90% of the baseline. This multi-centre audit assessed compliance with guidance regarding choice and administration method of vasopressors during caesarean delivery under spinal anaesthesia.

Methods

A multi-centre prospective audit of adult patients undergoing caesarean delivery under spinal anaesthesia was undertaken across the West Midlands, UK. Anonymised patient data was obtained during routine peri-operative care and audited across primary, process and clinical outcomes. The primary audit outcome was maintenance of intra-operative SBP at ≥90% baseline.

Results

Five-hundred-and-twenty-six patients were included. The primary outcome was achieved in 9.1% of cases. SBP was maintained within 80–90% of baseline in 65.0%, and below 80% of baseline in 25.9%. Phenylephrine was the first-line vasopressor in 91% of cases, administered via a rate-controlled device in 73.8%. Compliance with the international consensus recommendation for prophylactic phenylephrine via a rate-controlled device at 25–50 μg/min was 37.6%. Clinician-reported incidence of intra-operative nausea and vomiting were 24.9% and 8.4% respectively. Secondary analysis found that use of rate-controlled pump devices to administer prophylactic vasopressors was associated with reduced incidence of SBP decrease to <80% of baseline (P <0.01).

Conclusions

Intraoperative hypotension is common, and there is lack of adherence to guidance, including variation in choice and administration method of prophylactic vasopressors. Optimal management of hypotension should be incorporated into departmental guidance for enhanced recovery.