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

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. (C) 2009 Elsevier Ltd. All rights reserved.