| Abstract: | Hypotension is a significant problem during regional anaesthesia for caesarean section. This may be associated with both maternal and fetal morbidity. Risk factors should be identified. The technique of neuraxial blockade can be modified to reduce the incidence. Management techniques include left uterine displacement, mechanical leg compression, intravenous fluids and vasopressors. Novel alternative methods include transcutaneous electrical nerve stimulation (TENS) and 5HT3 antagonists. Neither pre-loading nor co-loading with intravenous fluid has been shown to be effective alone but must be combined with vasopressor administration by bolus or infusion. Phenylephrine by infusion is emerging as the vasopressor of choice, titrated to baseline blood pressure. Computerized target-controlled systems have been developed to facilitate titration. Cardiac output, rather than blood pressure, may be a more appropriate parameter for monitoring haemodynamic changes during caesarean section. |
