JKEP (JURNAL KEPERAWATAN)
Vol 9.
No 2.
November 2024 ISSN: 2354-6042 (Prin.
ISSN: 2354-6050 (Onlin.
Spinocan 27G with Trendelenburg 15A Position Post Induction Anesthesia Can Reduce the Incidence of Hypotension in Subarachnoid Block Anesthesia Rhesna Indra Gunawan*.
Sarka Ade Susana.
Sutejo Poltekkes Kemenkes Yogyakarta.
Indonesia *email: tanyarhesnaajaa@gmail.
Article history Posted.
June, 11th, 2024 Reviewed.
Oct, 14th, 2024 Received.
Nov, 19th, 2024 Copyright A 2024 Authors This work is licensed under a Creative Commons AtributionShareAlike 4.
0International License.
ABSTRACT
The surgery requires anesthesia, one of which uses the subarachnoid block anesthesia Hypotension is a complication of subarachnoid block anesthesia which ranks highest in 70,7% of 82 respondents in one study.
The prevalence of hypotension was reported in the last five years with different result each year starting 32,69%-76,9%.
Hypotension can lead to reduces conditions consciousness, pulmonary aspiration, hypoventilation, tissue hypoxia and even death.
This study to determine the comparison of the use of spinocan size and post anesthesia induction position on the incidence of hypotension in patients with subarachnoid block at RSUD Bendan Kota Pekalongan.
Analytical observation with cross sectional design.
The research was conducted in February - March 2024 with samples were 148 respondents with sampling using consecutive sampling technique based on inclusion and exclusion criteria.
Anesthesia used spinocan size 27G and 25G, blood pressure was measured by bedside monitor.
Data were analyzed using the Mann Whitney statistical test.
The result showed that 84/144 respondents .
8%) experienced hypotension.
Data normality test showed that the data not normally distributed.
The result of statistic test were obtained with p value 028 in the supine and trendelenburg groups with spinocan 27G.
The statistical test results were p value 0.
010 in in the supine and trendelenburg 15A groups with spinocan 25G.
Obtained statistical test results p value 0.
000 between the spinocan 27G and spinocan 25G groups in the incidence of hypotension.
The Conclusion of the study, the size of the spinocan 27G and trendelenburg 15A position group significantly reduced the incidence of hypotension compared to the spinocan 25G and supine position group.
Keywords: Hypotension.
Spinocan size.
Subarachnoid block.
Supine.
Trendelenburg 15A JKEP (Jurnal Keperawata.
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ABSTRAK
Tindakan operasi memerlukan pembiusan, salah satunya menggunakan teknik anestesi subarachnoid block.
Hipotensi merupakan komplikasi anestesi subarachnoid block yang menempati urutan tertinggi sebanyak 70,7% dari 82 responden dalam sebuah penelitian.
Prevalensi kejadian hipotensi dilaporkan dalam lima tahun terkahir dengan hasil yang berbeda tiap tahunnya mulai 32,69%-76,9%.
Hipotensi dapat mengakibatkan kondisi penurunan kesadaran, aspirasi pulmonal, hipoventilasi, hipoksia jaringan hingga kematian.
Penelitian ini untuk membandingkan penggunaan ukuran spinocan dan posisi post induksi anestesi terhadap kejadian hipotensi pada pasien dengan Subarachnoid Block di RSUD Bendan Kota Pekalongan.
Observasi analitik dengan cross sectional design.
Penelitian dilakukan pada Februari-Maret 2024 dengan sampel sebanyak 148 responden menggunakan teknik consecutive sampling berdasarkan kriteria inklusi dan eksklusi.
Pembiusan menggunakan spinocan ukuran 27G dan 25G, tekanan darah diukur menggunakan Bedside Monitor.
Data dianalisis menggunakan uji statistik Mann Whitney.
Hasil Penelitian Menunjukkan 84/148 responden .
8%) mengalami hipotensi.
Uji normalitas data didapatkan data berdistribusi tidak normal.
Didapatkan hasil uji statistik dengan p value 028 pada kelompok supine dan trendelenburg dengan spinocan 27G.
Hasil uji statistik p 010 pada kelompok supine dan trendelenburg dengan spinocan 25G.
Didapatkan hasil uji statistik p value 0.
000 antara kelompok spinocan 27G dan spinocan 25G terhadap kejadian hipotensi.
Kesimpulan penelitian ukuran spinocan ukuran 27G dan kelompok posisi trendelenburg 15A secara signifikan menekan angka kejadian hipotensi dibandingkan dengan spinocan ukuran 25G dan kelompok posisi supine.
Kata Kunci: Hipotensi.
Subarachnoid Block.
Supine.
Trendelenburg 15A.
Ukuran Spinocan.
INTRODUCTION
are reported with different results each The operation requires anesthesia, one of Puspitasari's research .
showed anesthesia technique.
Surgery using the According to Yuniar and Mutia .
, the subarachnoid block anesthesia procedure prevalence of hypotension is 42-63%.
also has side effects such as nausea.
Pratiwi noted that 73.
3% of respondents experienced hypotension (Pratiwi et al.
shivering, post dural puncture headache In Subhan's research, 76.
9% of respondents experienced hypotension post (Puspitasari.
Hypotension anesthesia which induction of subarachnoid block anesthesia (Subhan, 2.
This indicates that hypotension resulting respondents (Kusumastuti, 2.
Data on patients who underwent surgical techniques still occurs frequently.
These inconsistent results may be caused by anesthesia and experienced hypotension differences in characteristics that can JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 influence the decrease in blood pressure in September 2023 with an average number after induction of subarachnoid block ofpatients of 155 patients per month.
The incidence of hypotension in patients with subarachnoid block anesthesia is influenced by several factors BMI, prehydration fluids, puncture location, duration of surgery, length of puncture, agents/drugs, vasopressors, surgical manipulation and The aim of this study was to determine the comparison of the use of spinocan size and post-anesthesia induction position on the incidence of hypotension in patients with subarachnoid block at Bendan Hospital.
Pekalongan City.
The use of appropriate spinocan size and position post induction of anesthesia can increase the incidence of patient position (Puspitasari, 2.
hypotension during subarachnoid block Hypotension, if not treated properly, can pulmonary aspiration, hypoventilation and METHOD tissue hypoxia.
Severe hypotension can This research is an observational analytical cause cardiac arrest which represents a study using quantitative methods with serious complication of subarachnoid cross-sectional design.
The population in block anesthesia (Chusnah et al.
, 2.
this study were all patients who underwent anesthesia with Subarachnoid Block at IBS Several studies have looked at the scale of RSUD Bendan Kota Pekalongan.
The pain and the incidence of post dural sample was determined using consecutive puncture headache, but there has been no sampling technique, each group consisted of 37 respondents .
total of 148 respondent.
hypotension caused by choosing the size based on the criteria .
elective or of the spinocan.
The use of spinocan sizes emergency with ASA I Ae ASA i, .
aged 27G, 26G and 25G at RSUD Bendan Kota Ou17 years, .
Spinocan puncture a Pekalongan is still used because it has a maximum of three times .
patients very good success rate for subarachnoid cooperative and able to communicate.
block anesthesia.
Description of the incidence of hypotension post induction of subarachnoid block anesthesia at RSUD Bendan Kota Pekalongan, reaching 75% The research was carried out from the 3rd week of February to the 3rd week of March The instruments used were bedside JKEP (Jurnal Keperawata.
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The group IV, held for 3 minutes then returned components contained in the observation to the supine position.
Observe changes in sheet are: characteristics of the respondent blood pressure from baseline, 1st minute, 3rd minute, 6th minute, 9th minute and 12th minute post induction of anesthesia which consisting of type of operation, anesthetic are recorded in the observation sheet.
agent, spinocan size, and pre-induction Hypotension criteria are determined if the blood pressure .
, then post systolic blood pressure was a decrease Ou30 mmHg from the pre- induction blood pre-induction consisting of patient position and pressure pressure .
measurement blood post induction of The data analysis process in this study in four groups began with a normality test The way this study works, subjects who using the Kolmogrov-Smirnov normality meet the criteria to participate in the study The results of the normality test using undergo surgical preparation procedures, spinocan size and position post induction of anesthesia with the incidence of measurements are taken before and during hypotension were abnormally distributed, the results show p value = 0.
So, the anesthesia procedures are performed by a data analysis used was non-parametric senior anesthetist using a Quincke type statistical test, namely using the Man Spinocan 27G in group I and Whitney test with a confidence level of group II.
and Spinocan 25G in group i 95% or a significance level of p<0.
and group IV which was performed in the Research ethical suitability test at KEPK L3- L4 interspace area in a sitting position.
Poltekkes Kemenkes Yogyakarta with Bupivacaine heavy 0.
5% is injected ethical suitability letter No.
DP.
03/e- approximately 12 seconds with one KEPK.
1/157/2024.
non-invasive All After the spinocan needle is removed, the blood pressure is measured RESULT Univariate Analysis Systolic Blood Pressure (SBP) Supine position is given to group I and Based on the table 1, it shows that the group i.
Meanwhile, the Trendelenburg JKEP (Jurnal Keperawata.
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of respondents who were given included in the pre-hypertension category.
Meanwhile, the majority of the pre- spinocan 27G in the trendelenburg 15A induction SBP in respondents who were position, and spinocan 25G with supine given spinocan 25G with trendelenburg position was mostly 15A position, were in the hypertension which was Table 1.
Systolic Blood Pressure (Baselin.
in Respondents with Subarachnoid Block Anesthesia at RSUD Bendan Kota Pekalongan in 2024 .
Spinocan Spinocan 27G
27G with Supine Trendelenburg
Position Position Initial SBP
(%)
(%)
<90 mmHg 90-119 mmHg 120-139 mmHg 140-159 mmHg 160-179 mmHg >180 mmHg Source: Primary Data for February-March 2024 Groups Spinocan 25G with Supine Position (%) Spinocan 25G Trendelenburg Position (%) Table 2.
Decrease of Systolic Blood Pressure in Respondents with Subarachnoid Block Anesthesia at RSUD Bendan Kota Pekalongan in 2024 .
Spinocan Spinocan 27G
27G with Supine Trendelenburg
Decrease in Position Position SBP
(%)
(%)
No decline Decrease of 1-10 mmHg Decrease of 11-20 mmHg Decrease of 21-30 mmHg Decrease of 31-40 mmHg Decrease of 41-50 mmHg Decrease Ou51 mmHg Source: Primary Data for February-March 2024 Spinocan 25G with Supine Position (%) Groups Spinocan 25G Trendelenburg Position (%) Based on the table 2, it was found that all Recording the difference in the systolic groups experienced a decrease in systolic blood pressure of pre-induction .
and blood pressure after induction of anesthesia.
post induction of anesthesia to determine The difference between before and after subarachnoid block anesthesia experienced a decrease of O30 mmHg .
ot hypotensiv.
or decrease in blood pressure varied in each >30mmHg .
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 Incidence of Hypotension in Subarachnoid Block Anesthesia Table 3.
Frequency Distribution of the Incidence of Hypotension at RSUD Bendan Kota Pekalongan in 2024 .
Incidence of Hypotension Not Hypotension Hypotension (%) (%) Spinocan 27G with Supine Position Spinocan 27G Trendelenburg Position Spinocan 25G with Supine Position Spinocan 25G Trendelenburg Position Total Source: Primary Data for February-March 2024 Respondent Groups Table 3 shows that the majority of RSUD Bendan Kota Pekalongan experienced hypotension post induction of anesthesia.
Respondents who were given spinocan 27G with supine position experienced hypotension as many Total
(%)
Bivariate Analysis Referring to the research objectives, to determine whether there is a difference in the use of spinocan size and post-anesthesia induction position on the incidence of hypotension in patients with subarachnoid block, the Mann Whitney test was used.
as 17 respondents .
%).
Meanwhile, 8 respondents who were given spinocan 27G Based on table 4, the results show that the incidence of hypotension in respondents experienced hypotension .
6%).
who were given spinocan 27G with trendelenburg 15A position was less than The majority of hypotension incidents were The incidence of hypotension was found in respondents who were given higher in the group of respondents who spinocan 25G with supine position was 34 were given spinocan 27G with supine respondents .
9%), while 25 respondents position compared to the group of .
6%) who were given spinocan 25G respondents who were given spinocan 27G trendelenburg 15A position experienced with trendelenburg 15A position.
The results of the analysis using the Man Whitney statistical test showed that the p value = 0.
028<0.
There is a JKEP (Jurnal Keperawata.
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59/74
7%).
Meanwhile, 25/74 Meanwhile, in table 5 it can be seen that the majority of respondents who were given spinocan 25G with supine position and respondents who were given spinocan 25G with trendelenburg 15A position experienced hypotension.
The results of the analysis using the Man Whitney statistical test showed that the p value = 010 .
010<0.
There is a significant difference in the incidence of hypotension after induction of subarachnoid block respondents .
8%) who were given spinocan 27G experienced hypotension after induction of subarachnoid block The results of the analysis using the Man Whitney statistical test showed that the significance value of p value = 0.
000<0.
There was a significant difference in the incidence of Spinocan 27G and Spinocan 25G.
anesthesia with spinocan 25G in the supine position and trendelenburg 15A position.
Table 4.
Mann Whitney Test for Hypotension with Spinocan 27G with Supine dan Trendelenburg 15A Positions .
Spinocan and Position Supine Trendelenburg
Incidence of Hypotension Not Hypotension Hypotension (%) (%) Total
(%)
p value Table 5.
Mann Whitney Test for Hypotension with Spinocan 25G with Supine dan Trendelenburg 15A Positions .
Spinocan and Position Supine Trendelenburg
Incidence of Hypotension Not Hypotension Hypotension (%) (%) Total
(%)
p value JKEP (Jurnal Keperawata.
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Mann Whitney Test Incidence of Hypotension between Spinocan 27G and Spinocan 25G .
Incidence of Hypotension Not Hypotension Hypotension Spinocan Size
Spinocan 27G
Spinocan 25G
(%)
Total
(%)
p value (%) DISCUSSION drug Bunascan 0.
5% heavy .
yperbaric Decrease of Systolic Blood Pressure in Nugroho .
found that patients given hyperbaric bupivacaine Kota
experienced a decrease in systolic blood
RSUD
Bendan Pekalongan pressure in all patients.
Arteries and Based on table 1 regarding the pre- arterioles will experience dilation in areas experiencing sympathetic .
of respondents, it was found The that the majority of respondents' systolic sympathetic denervation, such as in bloodpressure was in the pre-hypertension hyperbaric bupivacaine, the more arteries category and also in the hypertension and veins will enlarge so that the High incidence of hypotension can increase (Fakherpour, 2.
The data presented shows that all respondents experienced a (Saputra, 2.
decrease in blood pressure with the Research conducted by Fajar .
at RSUD Bendan Kota Pekalongan showed that all subarachnoid block respondents majority experiencing hypotension after experienced anxiety with the majority Referring to table 2 regarding blood Respondents felt afraid or anxious about pressure reduction, it was found that the operation, so the patient was not calm respondents who were given spinocan during anesthesia.
This is supported by the statement by Romanik et al .
that experienced a decrease in systolic blood patients who have never experienced pressure of 31-40 mmHg.
Meanwhile, surgery will experience increased anxiety.
most of the respondents who were given spinocan 27G with trendelenburg 15A Anesthesia at RSUD Bendan Kota Pekalongan only uses the local anesthetic position experienced a decrease in systolic blood pressure of 11-20 mmHg.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 Most of the respondents who were given Pekalongan Based on the data presented in table 3, the experienced a decrease in systolic blood lowest incidence of hypotension pressure of more than 51 mmHg with the found in respondents who were given smallest decrease being 21-30 mmHg.
spinocan 27G with trendelenburg 15A Meanwhile, most of the respondents who position compared to respondents who were given spinocan 27G with supine trendelenburg 15A position experienced a Followed by respondents who decrease in systolic blood pressure of more than 51 mmHg with the smallest trendelenburg 15A position in third place, decrease being 11-20 mmHg.
while the respondents who experienced The majority of the decrease in systolic the most incidents of hypotension were found in respondents who were given subarachnoid block anesthesia in the spinocan 25G with supine position.
The groupof respondents with spinocan 25G incidence of hypotension post induction of experienced a quite extreme decrease, subarachnoid block anesthesia at RSUD while the decrease in systolic blood Bendan Kota Pekalongan was 84/148 pressure after induction of subarachnoid respondents .
8%).
Hypotension respondents with spinocan 27G was still within normal limits.
sympathetic fibers from thoracic 5 to People who have a history of high blood pressure are considered hypotensive if muscles, blocked arteries and veins.
their blood pressure drops >30mmHg Widespread sympathetic block can cause suddenly even though their blood pressure vascular vasodilation, decreasing cardiac values are still normal.
There is no output (Soenarjo, in Mutia, 2.
standard limit for groups of people who do The incidence of hypotension during not have a history of high blood pressure subarachnoid block anesthesia is still high or tend to have low blood pressure and occurs frequently.
Pratiwi .
in (Ramadhan, in Nurbudiman,2.
her research noted that 73.
3% of patients The Incidence experienced hypotension.
This was also supported by Subhan's .
Hypotension anesthesia at RSUD Bendan Kota JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 which found that 76.
9% of respondents experienced hypotension in her research.
This is different from the results of this compare the incidence of hypotension The incidence of hypotension post post induction of subarachnoid anesthesia with spinocan 25G in the anesthesia decreased quitedifferently, this supine and trendelenburg 15A positions, was due to different methods in terms of and compare the incidence of hypotension objective criteria.
post induction of subarachnoid The criteria for hypotension in Pratiwi's study were determined if there was a decrease in blood pressure of >20% below the pre-induction blood pressure, the criteria for hypotension in Subhan's study were determined if there was a systolic blood pressure <90 mmHg.
Meanwhile, in this study, the criteria for hypotension were determined if the systolic blood pressure fell Ou30 mmHg from the preinduction .
Apart from that, the size of the spinocan and the position post induction of anesthesia can reduce the incidence of hypotension in RSUD Bendan Kota Pekalongan, which was originally 75%, which has decreased to 56.
Next, anesthesia between spinocan size 27G and spinocan size 25G.
Anesthesia
RSUD
Bendan Kota Pekalongan only uses one type of spinocan namely the Quincke type spinocan.
In this study, subarachnoid block anesthesia was focused using spinocan 27G and spinocan The diameter of the needle is expressed in gauge, where the larger the gauge number means the smaller the needle diameter and lumen.
The diameter of the spinocan 25G is larger than the .
53x88mm VS Apart from that, the spinocan 25G was observed to have faster movement of cerebrospinal fluid than the spinocan 27G.
Comparison the use of spinocan size and post induction anesthesia position on patients with subarachnoid block at Research conducted by Arif .
found that an anesthetic injection at a slower speed .
2 mL/secon.
could reduce the incidence of post-anesthesia hypotension RSUD Bendan Kota Pekalongan compared to an anesthetic injection with a Researchers compared the incidence of fast injection .
4 mL/secon.
, there was a significant difference in systolic blood subarachnoid block anesthesia with JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 pressure between the two group.
This is in Hypotension line with the results of this study, anesthesia is caused by blockade of researchers linked the injection speed with sympathetic nerves which control blood the diameter of the spinocan to the impact vessel tone.
Blockade of sympathetic on changes in blood pressure.
The nerve fibers causes vasodilation in the decrease in systolic blood pressure tended veins, causing changes in blood volume, to be greater in the spinocan 25G group especially in the lower extremities and than in the 27G spinocan group.
There was splanchnicus, thereby a significant difference .
=0.
in the flow back to the heart (Tanambel, 2.
incidence of hypotension found in the Neal .
in Pujana Research .
spinocan 25G group which tended to be states that patients should be given the higher than in the spinocan 27G group
Trendelenburg
/74
after induction of subarachnoid block
25/74
ead anesthesia to maintain venous return.
Subarachnoid block anesthesia causes the When in the supine position, patients are arteries and veins around the blood vessels at risk of experiencing hypotension to enlarge, thereby reducing return flow to caused by venous pooling.
Venous pooling the heart, this can reduce cardiac output refers to the accumulation of blood in the and blood pressure (Kweon, et al.
, 2.
veins, especially in the lower extremities.
Patient position affects changes in blood caused by gravity, resulting in inefficient pressure and central venous pressure.
blood flow back to the heart.
Providing a Different trendelenburg 15A position post induction hemodynamics including the circulatory of anesthesia can help blood flow from the system (Cicolini, in Dwipayani, 2.
veins to the heart in the presence of In line with the results of the research This is supported by Rustini's conducted, the incidence of hypotension .
statement that hypotension can be found in the supine position group tended trendelenburg position.
trendelenburg 15A position group .
/74 Thus, based on the use of spinocan size, respondents VS 33/74 respondent.
This the incidence of hypotension was more is supported by research conducted by common in the spinocan size 25G group Yuniar .
, the majority of patients than in the spinocan size 27G group.
who were given the supine position Meanwhile, if we look at the post- experienced hypotension.
JKEP (Jurnal Keperawata.
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2 November 2024 hlm 197-210 Induction spinocan 25G in the supine position and hypotension was more common in the trendelenburg 15A Position.
Respondents who were given spinocan 27G with trendelenburg 15A position group.
The trendelenburg 15A position experienced highest incidence of hypotension was the least incidence of hypotension.
found in respondents who were given supine position.
Meanwhile, the lowest incidence of hypotension was in respondents who were given spinocan 27G with trendelenburg 15A position.
Therefore, using spinocan 27G with Trendelenburg 15A position post induction of anesthesia can reduce the incidence of hypotension in patients with subarachnoid block anesthesia.
Apart from that, the decrease in systolic blood pressure post anesthesia in the group of respondents who were given spinocan 27G with trendelenburg 15A position was still within normal limits.
The majority experienced a decrease in systolic blood pressure of 1120 mmHg
CONCLUSION
There is a significant difference in the incidence of hypotension post induction of subarachnoid block anesthesia with 27G spinocan with supine position and trendelenburg 15A position.
There is a significant difference in the incidence of subarachnoid block anesthesia with REFERENCES Arif.
, and Setiawan.
AoPerbandingan Efek Kecepatan Injeksi 0, 4 ml/dtk dan 0, 2 ml/dtk Prosedur Anestesi Spinal terhadap Kejadian Hipotensi pada Seksio SesariaAo.
JAI (Jurnal Anestesiologi Indonesi.
, 7.
, https://doi.
org/10.
14710/jai.
Chusnah,L.
Hubungan Usia dengan Kejadian Hipotensi pada Pasien dengan Spinal Anestesi di Instalasi Bedah SentralRSUD Bangil.
Sekolah TinggiIlmu Kesehatan Bina Sehat PPNI.
https://repositori.
id/handle/123456789/215 Dwipayani.
Hubungan Posisi Pembedahan Intra Operasi Dengan Kejadian Hipotensi Pada Pasien Spinal Anestesi di RSUD Klungkung.
Institut Teknologi dan Kesehatan Bali.
https://repository.
id/medias/journal/Ni_Made_ Sri_Dwipayani.
Fajar.
, and Susana.
AoTerapi Murottal Surah Ar-Rahman Menurunkan Kecemasan Pasien Pre Operasi Sectio Caesarea dengan Spinal AnestesiAo.
Media Keperawatan: Politeknik Kesehatan Makassar, 14.
, 4655https://ojs3.
id/index.
php/medperawat/arti cle/view/60/195 JKEP (Jurnal Keperawata.
Vol.
9 No.
2 November 2024 hlm 197-210 Fakherpour.
Ghaem.
Fattahi.
, &
Zaree.
AoMaternal and Anaesthesia-Related Risk Factors and Incidence of Spinal AnaesthesiaInduced Hypotension in Elective Caesarean Section: A Multinomial Logistic RegressionAo.
Indian Journal of Anaesthesia, 62.
, https://journals.
com/ijaweb/fullt ext/2018/62010/maternal_and_anaes thesia_related_risk_factors_and.
Kusumastuti.
Gambaran Kejadian Komplikasi Minor Pasca Anestesi Spinal pada Sectio Caesarea di Rumah Sakit Umum Kertha Usada Buleleng.
Institut Teknologi dan Kesehatan Bali.
https://repository.
id/medias/journal/17D10098 NI_MADE_KUSUMASTUTI_B.
Morgan & Mikhail's.
Clinical Anestehesiology 6th Edition.
USA:
Mc Graw Hill Education Lange.
Mutia.
Hubungan KetinggianBlok Spinal Anestesi dengan Kejadian Hipotensi Intra Operatifdi IBS RSUDSleman.
Poltekkes Kemenkes Yogyakarta.
http://eprints.
id/26 Nugroho.
Pujo.
, & Pusparini.
AoPerbandingan Efektivitas Anestesi Spinal Menggunakan Bupivakain Hiperbarik dengan Bupivakain Isobarik Pasien Menjalani Prosedur Operasi Abdomen Bagian Bawah di RSUP Dr.
KariadiAo.
JAI (Jurnal Anestesiologi Indonesi.
, 11.
, 116126.
https://doi.
org/10.
14710/jai.
Nurbudiman, .
Hubungan Jumlah Perdarahan Dengan Kejadian Hipotensi Pada Pasien Sectio Caesarea Dengan Spinal Anestesi Di Rsud Banjarnegara.
Poltekkes Kemenkes Yogyakarta.
http://eprints.
id/25 Pratiwi.
Faktor-Faktor yang Berhubungan dengan Kejadian Hipotensi pada Pasien Intra Operasi menggunakan Teknik Regional Anestesi.
Poltekkes Kemenkes Yogyakarta.
http://eprints.
id/81 Pujana.
Gambaran Kejadian Hipotensi pada Pasien Pasca Spinal Anestesi di RSU Kertha Usada Buleleng 2021.
Institut Teknologi dan Kesehatan Bali.
https://repository.
id/medias/journal/17D10025 _I_Wayan_Pujana.
JKEP (Jurnal Keperawata.
Vol.
9 No.
2 November 2024 hlm 197-210 Puspitasari.
Faktor-Faktor yang Mempengaruhi Kejadian Hipotensi pada Pasien dengan Spinal Anestesi di RSUP Dr.
Soeradji Tirtonegoro Klaten.
Poltekkes KemenkesYogyakarta.
http://eprints.
id/35 Romanik.
KaEski.
Soluch.
, and SzymaEska, .
AoPreoperative Anxiety Assessed by Questionnaires Patient DeclarationsAo.