Spinal-induced hypotension at caesarean section

Spinal anaesthesia is preferred for caesarean section, yet hypotension remains a significant problem and may adversely affect mother and baby. Understanding the physiological causes is essential to direct management. The international consensus of management includes vasopressors, intravenous fluids and avoidance of aorto-caval compression. Phenylephrine by infusion is now the vasopressor of choice. Low-dose spinal anaesthesia can reduce the incidence but risks inadequate anaesthesia. Novel means of predicting or more rapidly detecting spinal-induced hypotension include the use of continuous non-invasive blood pressure and cardiac output monitoring devices. Computer-aided closed-loop feedback systems with automated delivery of vasopressors permit timely treatment but remain outwith clinical practice.