[Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension]

Area of Science:

• Anesthesiology
• Obstetrics
• Pharmacology

Background:

• Hypotension is a frequent complication during spinal anesthesia for cesarean section, occurring in 55-90% of cases if unmanaged.
• This maternal hypotension can lead to adverse outcomes for both mother and fetus.

Purpose of the Study:

• To evaluate preventive and curative strategies for managing hypotension during spinal anesthesia for cesarean delivery.

Main Methods:

• A systematic review of Medline-database trials published in English or French.
• Analysis of data concerning hypotension during spinal anesthesia for cesarean section.

Main Results:

• Crystalloid preload alone is ineffective; colloid preload is a potential second-line treatment.
• Ephedrine, while historically used, shows limited prophylactic efficacy and potential adverse effects.
• Prophylactic phenylephrine, with or without ephedrine, is effective with fewer side effects.
• Co-/post-loading with crystalloids enhances hemodynamic control when used with vasopressors.

Conclusions:

• Systematic detection, prevention, and prompt treatment of hypotension are crucial.
• The combination of vasopressors (phenylephrine +/- ephedrine) and rapid crystalloid administration during spinal injection is the current optimal strategy.