Document Detail


Maternal hypotension during spinal anaesthesia for caesarean delivery.
MedLine Citation:
PMID:  23135692     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Purpose of review: To review maternal hypotension during caesarean delivery with spinal anaesthesia. Obstetric complications, such as obstetric haemorrhage and problems related to concomitant maternal diseases are not considered. Findings: Reports of hypotension during spinal anaesthesia for elective caesarean delivery are frequent (70- 80%) when pharmacological prophylaxis is not used. Although some physical methods (leg wrapping, thromboembolic stockings) and the prevention of aorto-caval compression (left lateral tilt of the uterus) are useful, main prevention relies on two pharmacological methods, vasopressor therapy and intravascular fluid loading generally in combination. Ephedrine has been the vasopressor of choice in obstetrics for decades but phenylephrine is now the preferred first line approach during elective procedures at least. Crystalloid preloading is clinically ineffective and should be abandoned. Crystalloid coloading at the onset of sympathetic blockade is better but its efficacy may depend on the volume infused and the speed of administration. Preloading with hydroxyethylstarch is more consistently effective in reducing the incidence and severity of hypotension and hydroxyethylstarch coloading appears equally effective. Preoperative tests and new monitoring devices are available to predict or permit early detection of hypotension, but their feasibility and reliability in routine clinical practice is not yet established. With these tools, it may become possible to tailor prophylaxis to the assessed risk of the individual. Summary: Combining a prophylactic vasopressor regimen with hydroxyethylstarch preloading, hydroxyethylstarch coloading or crystalloid coloading is the best method to decrease the incidence and severity of hypotension during spinal anaesthesia for caesarean delivery.
Authors:
F J Mercier; M Auge'; C Hoffmann; C Fischer; A Le Gouez
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-08
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Département d'Anesthésie-Réanimation. Hôpital Antoine-Béclère, AP-HP & Université Paris-Sud, - rederic.mercier@abc.aphp.fr.
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