Post-spinal anesthesia hypotension during cesarean delivery, a review article

Abstract

a b s t r a c tMaternal hypotension is a common complication after spinal anesthesia for cesarean delivery. Prevention and treatment of post-spinal hypotension (PSH) in cesarean delivery has been frequently investigated.Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols; thus, the use of fluid loading as a sole method for prophylaxis might be not satisfactory for many anesthetists. Phenylephrine is the preferred vasopressor for prevention and management of PSH in most cases. Ephedrine may be more beneficial in patients with bradycardia, patients with uteroplacental insufficiency and pre-eclamptic patients. Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH with minimal cardiac side effects.The high incidence of PSH with most of the pharmacological and non-pharmacological methods suggests the need for multimodal protocols for prevention and management of this problem. PSH in cesarean delivery is a common daily situation facing all anesthetists; thus, future research should focus on simple and rapid protocols that can be easily applied by anesthetists with moderate and low experience with minimal need to complex devices or costly drugs.

Adequate Dosage of Norepinephrine Infusion Combined with Goal-Directed Fluid Therapy During General Anesthesia May Improve Elderly Patients’ Postoperative Outcome Undergoing Lumbar Spinal Fusion

“…Intraoperative total uid volume and crystalloids, colloids volume in 0.030 µg.kg − 1 .min − 1 group were signi cantly higher than 0.060 and 0.090µg•kg − 1 •min − 1 . The incidence of intraoperative hypotension effectively decreased in 0.060µg•kg − 1 •min − 1 and 0.090µg•kg − 1 •min − 1 compared to 0.030µg•kg − 1 •min − 1 (6.7%vs33.3%, P = 0.01, 3.3% vs. 33.3%, P = 0.003).The frequency of bradycardia in 0.090 µg.kg − 1 .min − 1 group's patients was signi cantly higher than that in the dosage 0.030 µg.kg − 1 .min − 1 group (3%vs26%, P = 0.026) and 0.060 µg.kg − 1 .min − 1 group (3% vs. 6.7%, P = 0.038). Patients with 0.060 µg.kg − 1 .min − 1 had earlier rst intaking by 1.4 hours and rst atus by 1.1 hours.…”

“…This indicator can predict the adverse hemodynamic effects of uid depletion, as well as the bene cial effects of uid loading [5]. Norepinephrine is characterized by αadrenergic agonistic activity in addition to a weak β-adrenergic agonistic activity [6]. The compound does not reduce the heart rate and cardiac output, similar to that of phenylephrine.…”

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

“…The latest consensus for management of spinal hypotension during cesarean delivery recommends the use of prophylactic vasopressors in all non-hypertensive mothers [1]; however, maternal hypotension is still present even in mothers receiving prophylactic vasopressors. Thus, management of maternal hypotension using vasopressor boluses is necessary [2]. The commonly used vasopressors during cesarean delivery are ephedrine, phenylephrine, and recently norepinephrine (NE) [2].…”

“…Thus, management of maternal hypotension using vasopressor boluses is necessary [2]. The commonly used vasopressors during cesarean delivery are ephedrine, phenylephrine, and recently norepinephrine (NE) [2]. The use of ephedrine may be accompanied by maternal tachycardia and neonatal acidosis [2].…”

Effectiveness of Intravenous Prophylactic Phenylephrine for the Prevention of Spinal Anaesthesia Induced Hypotension during Caesarean Section. A Prospective Observational Study

“…However, nonpharmacologic mechanisms are associated with high incidence of high spinal block and unilateral block especially when hyperbaric local anaesthetics are used [23]. As pharmacologic methods, are associated with hemodynamic instability (refractive hypertension, bradycardia, and tachycardia) and fetal acid base disturbance and uterine vasoconstriction [24][25][26], other modalities such as fluid administration, left lateral position and trendelenburg positions should be considered [27,28].…”