Professional paper
https://doi.org/10.20471/acc.2019.58.s1.13
Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy
Ivan Šklebar
orcid.org/0000-0002-4557-7626
; Clinic for Anaesthesiology, Reanimatology and Intensive Care, “Sveti Duh” University Hospital Zagreb, Zagreb, Croatia; Catholic University of Croatia; Osijek Faculty of Medicine, Osijek, Croatia; Bjelovar University of Applied Sciences, Bjelovar, Croatia
Tonka Bujas
; Dr. Josip Benčević General Hospital, Department of Anaesthesiology, Reanimatology and Intensive Care, Slavonski Brod, Croatia
Dubravko Habek
orcid.org/0000-0003-1304-9279
; Catholic University of Croatia; Sveti Duh University Hospital, Clinic for Gynaecology and Obstetrics, Zagreb, Croatia
Abstract
Regional centro-axial anaesthesia, primarily spinal block, is the preferred method of anaesthesia for elective caesarean section because it entails fewer risks for the mother and the foetus compared to general anaesthesia. The most common side effect associated with spinal block is hypotension due to sympatholysis, occurring in up to 75% of cases. Spinal block-induced sympatholysis leads to vasodilatation and consequently causes maternal hypotension, which may compromise uterine blood flow and foetal circulation, and thus cause foetal hypoxia, bradycardia and acidosis. The selection of the most efficient treatment strategy to achieve haemodynamic stability during spinal anaesthesia
for caesarean section continues to be one of the main challenges in obstetric anaesthesiology. A number of measures for the prevention and treatment of spinal block-induced hypotension are used in clinical practice, such as preloading and coloading with crystalloid and/or colloid infusion, wrapping of lower limbs with compression stockings or bandages, administering an optimal dose of local anaesthetic and achieving an optimal spinal block level, left tilt positioning, and administering inotropes and vasopressors. Instead of administering vasopressors after a drop in blood pressure has already occurred,
the latest algorithms recommend a prophylactic administration of vasopressor infusion. The preferred vasoconstrictor in this case is phenylephrine, which is associated with a lower incidence of foetal acidosis, and maternal nausea and vomiting compared to other vasoconstrictors.
Keywords
spinal anaesthesia; caesarean section; hypotension; crystalloids; colloids; vasopressors; ephedrine; phenylephrine; norepinephrine; ondansetron
Hrčak ID:
224331
URI
Publication date:
1.7.2019.
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