Strategies for Prevention of Spinal-associated Hypotension During Cesarean Delivery: Are We Paying Attention?

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(Can J Anaesth 2017;64:991–996)Spinal anesthesia (SA)-induced hypotension is a common complication during cesarean delivery (CD) and can cause a wide range of adverse maternal and neonatal outcomes if untreated. Moore et al’s clinical trial aimed at assessing the median seated time to prevent hypotension in 50% of parturients undergoing elective CD after SA using an up-down sequential methodology. The participants were randomized to receive either 11.25 or 15 mg hyperbaric bupivacaine along with fentanyl 15 µg and morphine 150 µg. It was noted that the median seated time in the 11.25 mg bupivacaine group was a little more than 2 minutes whereas in the 15 mg bupivacaine group the median seated time was approximately 8 minutes, suggesting that extended seated time after SA could prevent hypotension in CD. Further studies elucidating the association of extended seated time and hypotension are essential to design effective prevention strategies for hypotension in CD. The current study was only powered to detect the intervention that prevented hypotension in 50% of patients, which questions its clinical relevance. Disadvantages of the prolonged seated strategy include a delay in surgical start time, reduced operating room efficiency, and shorter duration of anesthesia.

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