CROSS-SECTIONAL STUDY

Background: Spinal anesthesia is a regional anesthetic inhibiting the spinal nerves in surgical attempts. Spinal anesthesia also has complications, one of which is hypotension. Purpose: to determine the factors of hypotension in patients with spinal anesthesia at Mayjend Hospital. H. M. Ryacudu North Lampung. Methods: Using analytic correlation with a cross-sectional approach. Sample technique with purposive sampling. The number of samples was 56 respondents. The study used observations containing post-anesthesia data including age, gender, BMI, type of drug, and the incidence of hypotension. Findings: The age of the respondents was mostly in the early adult category, 21 (37.5%). The male gender is 28 (50%) and the female is 28 (50%), the majority of BMI with the normal category is 24 (42.9%), the type of anesthesia is Bupivacaine 28 (50%), and Levobupivacaine 28 (50%). There is no relationship between age, gender, and type of drug with hypotension with p_value>0.05. Conclusion: there is a relationship between BMI and hypotension in post-spinal anesthesia patients at RSD Mayjend. H. M. Ryacudu North Lampung with a p-value of 0.00 (<0.05).


Introduction
Anesthesia is the loss of all modalities of sensation including pain, touch, temperature, and position/proprioceptive sensation.Anesthesia itself is divided into general anesthesia and regional anesthesia.General anesthesia works to suppress the hypothalamic pituitary adrenal axis, while regional anesthesia works to suppress the transmission of pain impulses and suppress the efferent autonomic nerves to the adrenals (1).
The administration of anesthesia is always required to be as optimal as possible so as to avoid accidents and complications.However, in principle, complications associated with the administration of anesthesia are inevitable.Even the most experienced and considerate practitioners cannot avoid complications even if they act by the standards of care (2).
Spinal anesthesia has side effects in the form of hypotension where there is arterial blood pressure >20% with MAP below 60 mmHg (3).Normal blood pressure ranges between 90/60 mmHg and 120/80 mmHg.When blood pressure is below this range, a person can be said to suffer from low blood pressure or hypotension.It can also be influenced by high spinal blockade (3) Other factors include the type of anesthetic drug, age, gender, body weight, the patient's physical condition, the patient's position, and the length of the operation (4).The hypotension results occurred mostly in patients with a non-ideal body weight of 65.5%-medical record data for spinal anesthesia at RSD Mayjend.H. M. Ryacudu used bupivacaine and Levobupivacain.The age of patients who underwent spinal anesthesia was obtained at an age of more than 30 years.Based on the description above, researchers are very interested in researching factors related to the incidence of hypotension in patients with spinal anesthesia at RSD Mayjend.H. M. Ryacudu.

Methods
This study uses a correlation design with a cross-sectional approach to determine the factors that cause hypotension in spinal anesthesia patients.Based on the results of the study, it was found that the age of patients with spinal anesthesia at Mayjend Hospital.H. M. Ryacudu obtained early adults 21 (37.5%), late adults 14 (25%), early elderly 5 (8.9%), late elderly 6 (10.7%) and seniors obtained 10 (17.9%).In the age category, the majority are in the early adult category with an age range of 26-35 years at 37.5%.
In general, there is an increase in age in individuals that will have an impact on arterial stiffness and a faster pulse, a heartbeat that has an impact on high blood pressure compared to individuals who are still teenagers or young.In the gender found in the study, 28 (50%) women and 28 (50%) men were obtained.Sex is a biological trait and is inherent forever.The definition of sex is the difference between the two sexes which is determined biologically (5).
The results of the study of the type of anesthesia of patients with spinal anesthesia at RSD Mayjend.H. M. Ryacudu Hospital obtained 28 (50%) bupivacaine and 28 (50%) Levobupivacain (Levica).Bupivacaine is often given by spinal injection before surgery and to reduce pain after surgery.The potential effects of levobupivacaine are like bupivacaine in that, in general, the onset, duration of sensory block of both levobupivacaine and bupivacaine in balanced doses are equipotent.The emergence of hypotensive side effects, caused by the administration of isobaric levobupivacaine is less than patients with hyperbaric bupivacaine.Based on BMI of patients with spinal anesthesia at RSD Mayjend.H. M. Ryacudu, there were 12 (21.4%)thin, 24 (42.9%)normal and 20 (35.7%) fat (6).BMI is a step in assessing balanced nutritional status whether there is a lack or excess weight.A person's Body Mass Index is obtained from body weight divided by height (kg/m2).BMI has a positive correlation with total body fat, but BMI is not the only indicator to measure obesity, there are other methods in measuring body anthropometry by measuring abdominal circumference or waist circumference (P2PTM RI, 2019).
Another study found that respondents who underwent spinal surgery were mostly with ideal BMI with a total of 64 people (72.7%).Based on the results of the study, Ryacudu obtained hypotension in the amount of 30 (53.6%) and normal in the amount of 26 (46.4%) (7).

The relationship between age and postspinal anesthesia hypotension at RSD Mayjend. H. M. Ryacudu Hospital.
Based on the results of the study of the relationship between age and the incidence of hypotension in the p_valaue of 0.145, there is no relationship between age and the incidence of hypotension after spinal anesthesia at Mayjend Hospital.H. M. Ryacudu this can be due to most patients in the early adult age category.Research shows that there is a tendency for a greater decrease in blood pressure in older age groups.At an older age there is a decrease in cardiac output and changes in baroreceptors and sympathetic nervous system responses that cause a decrease in blood pressure (Ali et al., 2019) while in most respondents with advanced age so that it is a factor associated with the incidence of hypotension (8).Age is a period since humans were born and can be measured using units of time.It was found that 2.5% of patients experienced complications after undergoing anesthesia.The incidence of hypotension in the elderly can be caused by cardiovascular function that begins to decline.The cardiovascular system that begins to decline causes the elasticity of blood vessels to decrease so that it is easy for vasodilation to occur in blood vessels when exposed to cold temperatures in the operating room, body heat will escape to adjust the environmental temperature so that patients easily experience hypothermia, and the body will compensate which causes hypotension.In the late elderly, possibility of hypotension will be greater than in the early elderly when exposed to cold temperatures in the operating room (9).Researchers assume that the patient's reaction to a decrease in blood pressure after spinal anesthesia in early adulthood usually occurs less severe hypotension than the elderly with the same height of spinal anesthesia.In early adult patients, sympathetic block until midthoracic may not cause hypotension or only mild hypotension while in old age, block with the same height will occur severe hypotension (10).Therefore, the higher the age of the respondent, the higher the risk of experiencing hypotensive events.
The relationship between gender and postspinal anesthesia hypotension at RSD Mayjend.H. M. Ryacudu.Based on the results of the study on the relationship between gender and the incidence of hypotension, it was found that the value was 0.06, there was no relationship between gender and the incidence of hypotension in patients after spinal anesthesia at RSD Mayjend.H. M. Ryacudu Hospital.In the study, there was no relationship between gender and the occurrence of hypotension, this happened because the respondents in this study were equal in number between men and women with the number of female hypotensive events totaling 19 and men who experienced hypotension totaling 11.

The relationship between BMI and postspinal anesthesia hypotension at RSD Mayjend. H. M. Ryacudu.
Based on the results of the study, the relationship between BMI and the incidence of hypotension was found to have a value of 0.000 and there was a relationship between BMI and the incidence of hypotension after spinal anesthesia at Mayjend Hospital.H. M. Ryacudu.Excess BMI is very potential for obesity because the metabolic process decreases and is not balanced by an increase in physical activity or a decrease in the amount of food, then excess calories will be converted into fat which causes obesity.Arifin's research shows that obesity is closely related to the penchant for eating high-fat foods which increase the risk of increased blood pressure.The greater the body mass, the greater the volume of blood needed to supply oxygen and food to the body tissues.As a result, the artery walls will be subjected to greater pressure leading to an increase in blood pressure.In addition, being overweight also increases heart rate frequency.In line with (7) in his research, respondents with spinal anesthesia mostly experienced hypotension 55.6%.(3).

The relationship between drug type and hypotension in post-spinal anesthesia patients at RSD Mayjend. H. M. Ryacudu
Based on the results of the study of the relationship between the type of drug and the incidence of hypotension, the value was 0.789, there was no relationship between the type of drug and the incidence of post-spinal anesthesia hypotension at Mayjend Hospital.H. M. Ryacudu Hospital.Clinically significant drug interactions are most often caused by changes in pharmacokinetics secondary to modulation of drug metabolism.Pharmacodynamic interactions occur when the pharmacologic effects of the object drug are stimulated or inhibited by a precipitating drug.Pharmacokinetic interactions can be caused by interference with drug absorption, metabolism and/or elimination of the object drug by the precipitating drug (11).
The selection of local anesthetic drugs is based on the duration of the block produced.There are 2 types, namely short acting derived from the ester group, for example procaine and lidocaine, while for long acting derived from the amide group, for example bupivacaine, ropivacaine and tetracaine.The amide group is known to provide both sensory and motor block, which is often used in Indonesia is the drug bupivacaine, bupivacaine has an onset of 5-8 minutes with a duration of 90 -150 minutes, while the dose used ranges from 8 -10 mg for perineal area surgery and 15 -20 mg for inferior extremity surgery (12).Tachycardia is a condition when the heart rate exceeds 100 beats per minute.The condition of accelerating the heart rate is normal when someone is exercising, or as a response to stress, trauma, and disease.Tachycardia can be said to be abnormal when the chambers or chambers of the heartbeat faster, even when at rest.There are several types of abnormal tachycardia based on the place and cause, namely tachycardia in the chambers or atria (atrial fibrillation and atrial flutter), and tachycardia in the chambers or ventricles (ventricular and supraventricular tachycardia) (5).Ramdan's research (2022) showed that most respondents with spinal anesthesia had a pulse rate in the bradycardia category of 56.3%.According to Yüksek (2021), the use of spinal techniques in patients undergoing cesarean section can affect hemodynamic changes, namely a decrease in systolic pressure, diastolic pressure, and mean arterial pressure, and an increase in pulse frequency.In general, stimuli that increase heart rate also increase blood pressure, while those that decrease heart rate also decrease blood pressure.But there are exceptions such as the occurrence of hypotension and tachycardia due to stimulation of atrial stretch receptors (Juliarta, 2014).

Conclusions
The age of patients with spinal anesthesia is mostly with early adulthood 37.5%.The majority of BMI is normal with 24 (42.9%),giving 50% Bupivacaine and 50% Levobupivacaine types of anesthesia.There is a relationship between BMI and hypotension in post-spinal anesthesia

Factors
Associated with the Incidence of Hypotension in Patients with Spinal Anesthesia Gani et al.Java Nursing Journal, Vol 2, Issue 2, 2024, ISSN 2988-4152 174 the characteristics of the incidence of hypotension in patients with spinal anesthesia at Mayjend Hospital.H. M.

Table 4 .
The population in the study was 65 patients with spinal anesthesia.Determination of the sample with purposive sampling and obtained 56 patients.Research gets EC on the number.B.LPPM-UHB/2318/09/2023.The relationship between BMI and post-spinal anesthesia hypotension at RSD Mayjend.H. M. Ryacudu Hospital

Table 5 .
The relationship between drug type and hypotension in post-spinal anesthesia patients at Mayjend Hospital.H. M. Ryacudu Hospital obtained a p-value of 0.789 (more than 0.05) there is no relationship between the type of drug and the incidence of hypotension at Mayjend Hospital.H. M. Ryacudu Discussions Characteristics of patients with spinal anesthesia at RSD Mayjend.H. M. Ryacudu Hospital.