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Predicting spinal hypotension during Caesarean section

Hypotension under spinal anaesthesia for Caesarean section remains a common problem, with attendant maternal and foetal morbidity. This review examines some of the issues surrounding the prediction of spinal hypotension, including concerns about current evidence, the debate on the mechanism of hypotension and the utility of prediction in this group of patients. It then covers some of the more conventional and established preoperative predictors of hypotension. Particular attention is paid to the assessment of autonomic function and some of the novel methods being used as predictors of severe maternal hypotension. The implications of autonomic dysfunction and areas for future research are discussed.