A survey of the management of spinal-induced hypotension for scheduled cesarean delivery.

Journal Article

BACKGROUND: Intravenous fluids and vasopressors are used for managing spinal-induced hypotension during cesarean delivery, but the choice of vasopressor and the type and timing of fluid administration remain controversial. METHODS: We conducted an electronic survey of all members of the Society for Obstetric Anesthesia and Perinatology between February and March 2007 to determine their preferences for preventing and treating spinal-induced hypotension with respect to fluid and vasopressor administration. RESULTS: The response rate was 292/746 (39%). Fifty percent worked in academic institutions and 56% had >50% of their clinical responsibility to obstetric anesthesia. For prophylaxis, 35% used fluid preloading, 30% fluid preloading with vasopressors, and 12% fluid co-loading with vasopressors. Of those using vasopressors for prophylaxis, 32% used ephedrine, 26% used phenylephrine, and 33% based their choice on heart rate. For treatment, 32% used ephedrine, 23% used phenylephrine, and 41% used either agent based on heart rate. Anesthesiologists in academic practice were less likely to use fluid preloading only (P=0.028) and more likely to use fluid co-loading and vasopressors (P=0.003). They were also more likely to administer phenylephrine for prophylaxis compared with those in private practice (P=0.042). CONCLUSION: Significant variations in practice exist in the prevention and treatment of spinal-induced hypotension. Fluid preloading and the prophylaxis and treatment of hypotension with ephedrine continue to be common practices.

Full Text

Duke Authors

Cited Authors

  • Allen, TK; Muir, HA; George, RB; Habib, AS

Published Date

  • October 2009

Published In

Volume / Issue

  • 18 / 4

Start / End Page

  • 356 - 361

PubMed ID

  • 19734039

Electronic International Standard Serial Number (EISSN)

  • 1532-3374

Digital Object Identifier (DOI)

  • 10.1016/j.ijoa.2009.03.014

Language

  • eng

Conference Location

  • Netherlands