AANA August 2022 Journal Course: Evidence-based Prevention Strategies for the Management of Spinal Anesthesia-Induced Hypotension in Healthy Parturients Undergoing Elective Cesarean Delivery-Article

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This article provides a systematic review of the management and prevention of spinal anesthesia-induced hypotension in healthy parturients undergoing elective cesarean delivery. Spinal anesthesia is the preferred technique for uncomplicated elective surgeries in the parturient population due to its advantages, such as excellent surgical analgesia, patient awareness during fetal delivery, and low maternal morbidity. However, spinal anesthesia-induced hypotension remains a common complication, with an incidence as high as 70-80% without appropriate prophylaxis. Maternal hypotension can lead to nausea, compromised uteroplacental perfusion, and fetal distress.<br /><br />The review explores the physiology of spinal anesthesia-induced hypotension and identifies unique risk factors in parturients. It also analyzes the current evidence-based interventions for preventing hypotension in this population. The review focuses on both pharmacological and non-pharmacological strategies.<br /><br />Pharmacological interventions include the use of intravenous fluids, such as crystalloids or colloids, as well as vasopressor drugs like phenylephrine or ehedrine. The timing, type, and volume of fluid administration are important considerations. Non-pharmacological methods involve the use of lower limb pneumatic sequential compression devices.<br /><br />The article highlights the need for the implementation of evidence-based guidelines and practices to decrease the incidence and severity of spinal anesthesia-induced hypotension in parturients undergoing elective cesarean delivery. It emphasizes the importance of a multidisciplinary approach and further research to optimize prevention strategies and improve maternal and fetal outcomes.

Keywords

spinal anesthesia-induced hypotension

management

prevention

healthy parturients

elective cesarean delivery

advantages of spinal anesthesia

maternal hypotension

risk factors

pharmacological interventions

non-pharmacological methods