Neuraxial anaesthesia-induced hypotension during Caesarean section

Question 1

Spinal anaesthesia-mediated hypotension

Answer 1

Hypotension caused by the blockade of preganglionic sympathetic nerve fibres causing arterial vasodilation, venodilation and peripheral blood pooling

Question 2

RFx for spinal anaesthesia-mediated hypotension

Answer 2

• High BMI
• Wt gain in pregnancy
• Gravida >3
• Previous hypotension
• Higher baseline HR

Question 3

Non-pharmacological Management of spinal anaesthesia-mediated hypotension

Answer 3

• Fluids: no clear benefit of preload or co-load
• Positioning: Less hypotension in lateral position, following spinal lt lateral tilt is key

Question 4

Pharmacological Management of spinal anaesthesia-mediated hypotension

Answer 4

• Ephidrene - crosses placenta and can cause foetal acidosis
• Phenylephrine
• Noradrenaline
• Adrenaline