206 - Implementing a Spinal-Induced Hypotension Bundle for Elective Cesarean Sections

Description Spinal-induced hypotension (SIH) complicates up to 70% of cesarean deliveries and threatens maternal comfort and uteroplacental perfusion, predisposing the fetus to hypoxia, bradycardia, and acidosis. A recent chart review at a large metropolitan level 2 hospital confirmed that 58% of women who received spinal anesthesia for cesarean section experienced hypotension, underscoring a persistent practice gap despite the availability of evidence-based countermeasures. Accordingly, this quality-improvement project asks: In pregnant patients undergoing elective cesarean section, does implementation of a three-component Spinal-Induced Hypotension Management Bundle (SIHMB) reduce the incidence and severity of SIH compared with usual, non-standardized care?
Design/Concept

Description: The initiative is structured as a Plan-Do-Study-Act (PDSA) cycle, allowing iterative refinement while data accrue. During the Plan phase, an interprofessional team synthesized the best available literature and local baseline data to assemble the SIHMB protocol: (1) prophylactic intravenous ondansetron 8 mg given 5 to 10 min before intrathecal injection, (2) 1 L crystalloid co-loading under pressure commencing at spinal placement, and (3) a prophylactic phenylephrine infusion initiated at 50 mcg/min concurrent with block placement. Laminated quick-reference cards, targeted staff education, and guaranteed in-room drug/equipment availability support fidelity. The bundle's simplicity leverages medications that are already "top-drawer" in most obstetric operating rooms, facilitating sustainability and spread beyond the project unit.
Methodology: Following USF IRB determination of non-human research and hospital approval, adult patients age 18 to 45, scheduled for elective cesarean delivery with a singleton pregnancy will be enrolled over a six-month period: three months of retrospective pre-implementation data collection followed by three months of prospective bundle rollout. Exclusion criteria include allergy to bundle components, epidural or general anesthesia, or high-risk pregnancy. Approximately 90 to 120 cases (30 to 40/month) and 15 anesthesia providers (10 to 15 CRNAs, 5 anesthesiologists) are expected.
Primary outcomes are systolic and diastolic blood pressure nadirs within 10 min of spinal placement; secondary outcomes include intraoperative nausea/vomiting incidence and rescue vasopressor use. Process measures track individual bundle-component compliance. Data are de-identified and analyzed with IBM SPSS 29; normality testing dictates use of t-tests or Mann-Whitney U tests for continuous variables and X² tests for categorical data, with α < 0.05 denoting significance. Results will inform whether the SIHMB is adopted as standard practice, modified, or discontinued, and will be disseminated to stakeholders and the wider perioperative community via poster and manuscript formats.