[Hypotension induced by spinal anesthesia during cesarean section : Current treatment concepts]

Area of Science:

• Anesthesiology
• Obstetrics
• Cardiovascular Physiology

Background:

• Arterial hypotension during cesarean delivery under spinal anesthesia poses risks to mothers and fetuses.
• Current guidelines advocate for vasopressor use, particularly alpha-agonists like phenylephrine, for prevention.
• Fluid management strategies, including uterine displacement and pre/co-loading, are also recommended.

Purpose of the Study:

• To outline optimal strategies for managing arterial hypotension during cesarean delivery under spinal anesthesia.
• To emphasize the prophylactic use of continuous phenylephrine infusion for blood pressure maintenance.
• To define target blood pressure goals and initial dosing recommendations for phenylephrine.

Main Methods:

• Continuous prophylactic phenylephrine infusion initiated after intrathecal injection.
• Titration of phenylephrine dosage based on vital parameters.
• Implementation of left lateral uterine displacement and fluid pre/co-loading.
• Monitoring systolic arterial blood pressure to maintain at least 90% of baseline, avoiding drops below 80%.

Main Results:

• Continuous phenylephrine infusion is a recommended method to achieve target blood pressure goals.
• An initial phenylephrine dose of 25-50 µg/min is advised, adjusted as needed.
• Careful preoperative evaluation and individualized hemodynamic goals are crucial for patients with cardiac conditions.

Conclusions:

• Prophylactic continuous phenylephrine infusion is effective in preventing hypotension during spinal anesthesia for cesarean delivery.
• Adherence to blood pressure targets and individualized patient management are key to optimizing outcomes.
• Phenylephrine, as an alpha-agonist, is the preferred vasopressor in this setting.