Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice

Hypotension during obstetric spinal anaesthesia has traditionally been mana ged by such measures as fluid preloading, positioning of the patient and th e use of vasoconstrictors. However, studies and reports have regularly appe ared in the literature disputing the value of conventional management, in p articular, the fluid preload. With this in mind, we surveyed UK consultant obstetric anaesthetists to determine current practice in this area. Of the 558 respondents, 486 (87.1%) stated that they routinely give a fluid preloa d. The fluid chosen by 405 (83.3%) of the preloaders was Hartmann's solutio n and the usual volume, chosen by 194 (39.9%), was 1000 ml. A simple left l ateral position was preferred by 221 respondents (39.6%) overall and in the treatment of hypotension, ephedrine was the sole vasoconstrictor selected by 531 (95.2%). Heavy bupivacaine 0.5% was the local anaesthetic chosen by 545 (97.7%) and 407 (72.9%) respondents indicated the use of additional spi nal drugs.