Maternal Hypotension During Spinal Anesthesia for Cesarean Delivery

Spinal hypotension is a common problem encountered by anesthesiologists when providing spinal anesthesia (SA) for cesarean delivery (CD). Recent research involving use of noninvasive and minimally invasive cardiac output monitoring has improved our understanding of the many pathophysiological mechanisms involved. Crystalloid prehydration (or preload) regimens have failed to have any significant impact on prevention of spinal hypotension, although some benefit of use of either crystalloid or colloid coloading has been demonstrated. Vasopressors remain the mainstay of treatment for both prevention and management of spinal hypotension. Increasing evidence suggests that the vasopressor of choice during SA for CD is phenylephrine (PE), however care should be taken to avoid maternal sinus bradycardia. When PE is administered as an infusion, maternal heart rate and blood pressure should be monitored closely, and any significant decrease in either should be promptly and aggressively treated. © 2013, Springer Science + Business Media New York.