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Preventing spinal hypotension during Caesarean delivery: what is the latest?

Spinal hypotension is common in women who receive spinal anaesthesia for Caesarean delivery, with an incidence of up to 71%. Spinal hypotension can occur precipitously and, if severe, can result in important perinatal adverse outcomes, such as maternal nausea and vomiting, fetal acidosis and may be an important contributory factor for maternal death related to regional anaesthesia. 3 Mothers with pre-delivery hypovolaemia may be at risk of cardiovascular collapse because the sympathetic blockade may severely decrease venous return. As a consequence, prevention of spinal hypotension has been a key research area within the field of obstetric anaesthesia. To prevent spinal hypotension, a number of approaches have been investigated, notably fluid loading, vasopressors, or both. 5 Despite early enthusiasm, the efficacy of fluid loading for preventing spinal hypotension has been called into question. In contrast, the use of vasopressors has gained increasing prominence as the primary technique for the prevention and treatment of spinal hypotension during Caesarean delivery. – 10 This editorial aims to highlight key research findings pertaining to vasopressor regimens and how these regimens can be incorporated into clinical practice.