By Dr.K.SELVI D.A POST GRADUATE Co-authorsProf.Dr.R.SELVAKUMAR Prof Dr.B.CHANDRIKA Prof Dr.A.CHANDRASEKAR COIMBATORE MEDICAL COLLEGE

The correlation between the spread of local anesthesia in the sub-arachnoid space and hemodynamic changes has always been unpredictable and factors responsible for it are being under debate. This is more frequently experienced in spinal anesthesia for caesarian section.

To asses the level of analgesia and its degree of correlation with the hypotension and other side effects using standard spinal anaesthetic dosage in caesarean section. To asses the level of analgesia and its degree of correlation with the hypotension and other side effects using standard spinal anaesthetic dosage in caesarean section. To asses the degree of correlation of weight, height,BMI with hypotension. To asses the degree of correlation of weight, height,BMI with hypotension.

A sample of 50 patients who underwent Caesarean section (elective & emergency) 1.8 ml 0.5% of Bupivacaine in L3-L4 space with table positioned horizontally, patient lying in Rt lateral position,then patient was placed in supine position with a wedge under the right hip. Fall of more than 20% of systolic BP from the base line value was considered as hypotension and managed with inj.ephedrine in incremental dosage( 6mg )

Parameters like Pulse Pulse BP BP Spo2 Spo2 Level of block Level of block Side effects Side effects Time to reach maximum segment Time to reach maximum segment & Demographic details like Height Height Weight Weight BMI BMI

Maximum level of block Two segment regression time Level at the end of one hour Time to reach maximum segment Maximum level of block Time to reach maximum segment (minutes) Level at the end of one hour Two segment regression time (minutes) T4 4 ± 2 T5 ± 1 80 ± 16

Percentage of inj.ephedrine usage Nil usage < 6mg >6mg 38% 30% 32%

Side effects 1. Restlessness 2. vomiting Restlessness Vomiting 12% 44%

Sample % Weight (Kgs) Height (cms) BMI Time to reach maximum segment (minutes) Stable patients Patients with hypotensi on

Level of block No. of patients Nil ephedrine usage >6mg ephedrine usage T424(48%)3(12.5%)21(87.5%) T515(30%)6(40%)9(60%) T611(22%)8(72.7%)3(27.2%)

Restlessness There is no positive correlation of restlessness with hypotension SIDE EFFECTS No of patients who developed restlessness Inj.ephedrine used 6 (12%)3(6%)

Vomiting There is positive correlation of vomiting with hypotension. No of patients who developed vomiting Inj.ephedrine used 22(44%)16(32%)

So by giving 1.8 ml 0.5% of Bupivacaine in L3-L4,space with table positioned horizontally, patient was placed in supine position with a wedge under the hip. Incidence of hypotension -62% Incidence of restlessness-12% Incidence of vomiting-44%

As level of block increases severity of hypotension increases. There is positive correlation of weight,height & BMI with hypotension. There is a positive correlation between vomiting and hypotension. SUMMARY

According to my study level of block significantly decides the degree of hypotension. Height,weight,BMI & time to reach maximum segment are also the important co- factors in deciding the incidence of hypotension.