Risk Factors for Spinal Anesthesia – Induced Hypotension During the Elective Cesarean Section

Spinal anesthesia is widely considered the “gold standard” for elective cesarean sections due to its rapid onset and lower risk of complications compared to general anesthesia. However, hypotension is a common adverse effect, influenced by maternal and procedural factors. Despite various preventive measures, predicting hypotension based on patient characteristics remains challenging. This study investigated the relationship between hypotension and variables such as age, BMI, height, preoperative fasting, and hypertension during pregnancy. A retrospective analysis was conducted on 123 patients who underwent elective cesarean section under spinal anesthesia between April and August 2023 at the Clinic of Gynecology and Obstetrics, Novi Sad. Demographic data, anesthetic dose, timing of surgery, and blood pressure trends were collected. Patients were categorized according to delivery time, height, occurrence of hypotension, and history of hypertension. Statistical analyses included Student’s t-test, Mann–Whitney U, Shapiro–Wilk, chi-square tests, ANOVA, and correlation analysis. Hypotension occurred in 45.5% of patients. Older age was significantly associated with a higher incidence of hypotension (p = 0.031), whereas hypertension during pregnancy correlated with a lower incidence (p = 0.032). Height, BMI, and surgery timing had no significant impact on hypotension risk. Taller patients received a larger volume of anesthetic (p = 0.005), with a moderate correlation between height and dose (rs = 0.427, p < 0.001); however, anesthetic dose was not predictive of hypotension. Most hypotensive events occurred within 10 minutes following spinal anesthesia. In conclusion, hypotension was associated with older age, while hypertension during pregnancy appeared to have a protective effect. No significant associations were found with height, BMI, or fasting duration. These findings highlight the need for individualized monitoring and larger-scale studies to optimize spinal anesthesia management in cesarean delivery.