Vasovagal Shock and Syndrome Of Supine Hypotension In Patients Undergoing LsCs Under Spinal Anaesthesia

Physiologic effects of spinal anaesthesia involve the following systems of the body :-

1. Cardiovascular effects
2. Respiratory effects
3. Gastrointestinal functions
4. Renal functions

Complications include :-

• Neurological changes.
• Headache after spinal puncture.
• Backache
• Unexpected cardiac arrest 

VASOVAGAL SHOCK SYNDROME :-

I have observed the vasovagal shock symptoms (vvss) in patients under going Lscs just after spinal block which may be taken as  syndrome of supine hypotension (ssh)

As soon as the patient is turned on her back after spinal block , she feels uncomfortable, having sweating and yawning. She may develop bradycardia which if left untreated can lead to sudden cardiac arrest. This vvss is due to the fear of needle, pain and worry of well being of herself and her child. This is aggravated by hss.

TREATMENT:-

1. Anaesthesiologist should be VERY VIGILANT to avoid the morbidity and mortality of mother and child.
2. Mother should be hooked to EKG, oxymeter, and BP monitoring before giving regional block to the mother.
3. I/V line must be maintained before block.
4. Start rushing fluid.
5. Atropine is the drug of choice.
6. oxygenation of the patient by mask.
7. Ephedrine may be given if the patient does not respond to the above treatment.

The same symptoms may be observed during the syndrome of hypotension. During pre-anaesthetic check  up, patient gives history of discomfort, difficulty in breathing and pallor while lying supine. Upto 10% of pregnant patients at term show signs of severe hypotension in supine position. This phenomenon is termed as syndrome of supine hypotension. The decrease in cardiac out put is due to obstruction of inferior vena cava, compression of the aorta is generally not associated with maternal symptoms in a healthy parturient, but may be associated with decrease in utero placental perfusion.

The symptoms of ssh are best relieved by placing a block or pillow beneath the right lumber region. In addition to it, the above treatment is also very useful to treat it.

To conclude, 

• history of pallor, discomfort and sweating is impotant to differentiate ssh from vvss.
• vvss are aggravated when spinal block is given in sitting position
• VIGILENCE on part of anaesthesiologist is the key to achieve the target of 100% safe anaesthesia