Managing spinal anesthesia-induced hypotension in cesarean section: emerging techniques and evidence-based strategies – a narrative review

Maternal hypotension is a prominent adverse effect of spinal anesthesia (SA) in women undergoing cesarean sections (C-sections). It significantly impacts maternal and fetal well-being, emphasizing the need for effective management strategies. This article reviews the current management guidelines and analyzes the existing literature to shed light on the emerging approaches for managing SA-induced hypotension. Management strategies range from prophylactic measures, such as maternal repositioning and leg wrapping, to more extensive interventions, including fluid administration, vasopressors, and adjustment of anesthetic dosage. The management approach is also influenced by maternal conditions like diabetes, preeclampsia, and chronic kidney disease, as the factors contributing to blood pressure changes in these conditions guide the management of hypotension accordingly. The optimal strategy of choice is dictated by multiple factors including the degree of hypotension, maternal comorbid conditions, and the balance between the benefits and risks of the chosen method. The preferred approach should be tailored to the individual patient's needs and characteristics while also considering its impact on the fetus. Previous studies have shown that prophylactic administration of fluids, especially colloids, as they are proven to be more effective than crystalloids, and the judicious use of vasopressors like phenylephrine in conjunction with ondansetron, along with lowering the anesthetic dose, can significantly reduce the incidence of SA-induced hypotension and the potential adverse maternal and fetal implications.