Graduation Semester and Year

Spring 2025

Language

English

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Tiffany Trent, DNP, AGACNP

Abstract

Background: Spinal anesthesia is the preferred method for elective cesarean sections due to its rapid onset, ability to keep the mother awake, and lower risk of complications compared to general anesthesia (Shitemaw et al., 2020). However, spinal-induced hypotension (SIH), caused by a sympathetic block, occurs in up to 75% of cases (Sklebar et al., 2019). A 2019 global study conducted in Ethiopia of 410 women found the incidence of SIH in cesarean sections to be 64% (Shitemaw et al., 2020). A Texas study found that 99.4% of cesarean deliveries experienced SIH, and 12% of those cases resulted in severe hypotension, neonatal acidosis, and adverse maternal outcomes (Kazzi et al., 2023). Purpose: A gap analysis at a North Texas medical center, which reviewed 50 electronic health records, revealed that 52% of elective cesarean sections experienced SIH. This quality improvement project aimed to educate anesthesia providers and implement a bundle approach to reduce SIH. Methods: During eight weeks, a multimodal treatment bundle that included administering Zofran prior to spinal anesthesia, injecting the spinal dose slowly over 20 seconds, and providing a co-load fluid bolus during the spinal procedure was introduced. Data from 50 patients who received the bundle were compared to the gap analysis data. Results: The results demonstrated a significant reduction in nausea and vomiting (12% vs. 54%), vasopressor use (78% vs. 98%), and hypotension (24% vs. 52%) in the patients who received the multimodal bundle. Conclusion: These improvements suggest the treatment bundle effectively reduced SIH and supports a shift toward updated practices among anesthesia providers.

Keywords

Spinal-induced hypotension, Cesarean section anesthesia, Quality improvement, Obstetric anesthesia, Vasopressor reduction, Maternal outcomes, Zofran prophylaxis, Fluid co-loading, Co-loading, Spinal injection rate

Disciplines

Maternal, Child Health and Neonatal Nursing | Medicine and Health Sciences | Nursing

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