Control of blood pressure during spinal anaesthesia for caesarean section

SummaryMaternal hypotension during caesarean delivery under spinal anaesthesia may lead to adverse maternal and neonatal outcomes. Vasopressors commonly administered include phenylephrine and ephedrine. Phenylephrine (alpha-1 agonist) is now an established 1st line vasopressor compared to ephedrine (alpha- and beta-agonist) as it has rapid onset, is efficacious and titratable. Over.administration of phenylephrine may result in reactive hypertension. Ephedrine may cause increased foetal acidosis from increased placental transfer with increased foetal metabolism and oxygen consumption. Recent advances in vasopressor algorithms and delivery systems, together with non-invasive haemodynamic (blood pressure, cardiac output) monitoring may lead to refinement in the management of hypotension whilst reducing reactive hypertension.