An Observational Study on Arrhythmia During Cesarean Section Under Spinal Anesthesia: Incidence, Risk Factors, and Effects on Immediate Post-delivery Neonatal Outcome

Abstract

Introduction: Various types of arrhythmia have been reported during cesarean section under spinal anesthesia. But the possible causative factors and the effects of arrhythmia on immediate post-delivery neonatal outcome are not well established.Methods: This prospective observational study was conducted over a period of one year in a tertiary care hospital on women undergoing cesarean section under spinal anesthesia. The objectives of the study were to determine the incidence of arrhythmia, its types, the possible factors influencing arrhythmia, and the immediate post-delivery neonatal outcome. Data collected were analyzed using Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY).Results: In our study, the incidence of arrhythmia was 31.9% during cesarean section under spinal anesthesia; and sinus bradycardia was the most common type. Arrhythmia occurred more in women with hypotension, when maximum block height was above T 4 level and dose of intrathecal hyperbaric bupivacaine was more than 2.2 mL (P value <0.05). Also, uterine manipulation led to sudden bradycardia and transient cardiac asystole in two patients which was preceded by subjective symptoms of pain and discomfort. None of the neonates required cardiopulmonary resuscitation or neonatal intensive care unit admission within an hour of birth. APGAR (Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration) scores at 1 and 5 minutes were similar in all the newborns born to mothers with or without arrhythmia. Conclusion:The occurrence of arrhythmia during cesarean section under spinal anesthesia, though very common, is rarely life-threatening. Keeping maximum level of block height between T 4 and T 6, using lower possible drug dose to provide adequate level of sensory block, prompt management of hypotension, and strict monitoring during uterine manipulation may reduce the overall incidence of arrhythmia. Intraoperative arrhythmia, however, does not adversely affect the immediate post-delivery neonatal outcome.

Supraventricular Tachycardia Associated With Repeat Cesarean Section Under Spinal Anesthesia

“…Treatments include adenosine, beta-blockers, calcium channel blockers, and vagal maneuvers (eg., Valsalva and carotid body massage). The most common clinical manifestations of SVT include palpitations, shortness of breath, sweating, syncope, chest pain, and dizziness [4,5]. Our patient admitted feeling like her heart was racing but remained hemodynamically stable.…”

Incidence and Risk Factors of Spinal Anesthesia-Related Complications After an Elective Cesarean Section: A Retrospective Cohort Study

“…prospective study reported the incidence of mild, moderate, and severe maternal hypotension as 20%, 35%, and 40%, respectively [7]. Varying incidence rates of hypotension induced by SA have been reported globally as 56.5%, 64%, and 79.6% [10,11,12]. However, other studies reported SAIH incidence rates ranging from 7% to 74%.…”

Assessing the Efficacy of Inferior Vena Cava Collapsibility Index for Predicting Hypotension after Central Neuraxial Block: A Systematic Review and Meta-Analysis

“…Intraoperative hypotension, irrespective of its etiology, may have detrimental effects on patients' well-being in both immediate and prolonged periods. A sudden drop in blood pressure reduces perfusion to vital organs, making patients prone to arrhythmia, myocardial ischemia or infarction, acute kidney injury, and postoperative delirium [4,6,[35][36][37][38][39]. In a recent study of 216 women undergoing cesarean section, hypotension was observed in 79.6% of the cases, and a statistically significant association was found between hypotension and arrhythmia [35].…”

“…A sudden drop in blood pressure reduces perfusion to vital organs, making patients prone to arrhythmia, myocardial ischemia or infarction, acute kidney injury, and postoperative delirium [4,6,[35][36][37][38][39]. In a recent study of 216 women undergoing cesarean section, hypotension was observed in 79.6% of the cases, and a statistically significant association was found between hypotension and arrhythmia [35]. A retrospective cohort study involving 5127 patients undergoing noncardiac surgery found an association between postoperative acute kidney injury and prolonged intraoperative periods of mean arterial pressure (MAP) below 55 and 60 mmHg [39].…”