How to handle hypotension following spinal anesthesia for a cesarean section

Abstract

Spinal block is the chosen anesthetic technique for cesarean sections because it poses less hazards to the mother and fetus than general anesthesia. The most frequent adverse effect of spinal block is hypotension owing to sympatholysis, which can reduce preload and afterload and cause arterial and venous vasodilation. This leads to maternal hypotension, which can affect uterine blood flow and fetal circulation and result in fetal hypoxia, acidosis, and bradycardia. Since then, a number of research studies on various medications, techniques, and regimens have been published, and neuraxial anesthesia methods in obstetrics are becoming more and more common. Clinical practice employs a variety of strategies for the prevention and management of spinal block-induced hypotension, including intravenous colloid preloading or crystalloid coloading, compression bandages or stockings for the lower limbs, left tilt positioning, administering the ideal local anesthetic dose and attaining the ideal spinal block level, as well as the administration of inotropes and vasopressors as constriction of the arterial vessels is currently emerging as the ideal strategy. The most recent algorithms advocate giving vasopressor infusions as a preventative measure rather than when hypotension has already occurred.