Prompt

Spinal hypotension at caesarean section, and the complications that must not be missed

Viva Stems

Spinal, epidural or combined spinal-epidural for an elective caesarean — how do you choose?
What determines how high the spinal goes?
Her pressure falls to 85 — talk me through prevention and treatment.
Phenylephrine or ephedrine — defend your choice with numbers.
Day one: severe back pain and weak legs with an epidural in situ. What now?
She is anticoagulated. When can you place and remove the block?
How much intrathecal morphine, and what monitoring?
Postural headache after a wet tap — workup and treatment.

References11Show

[1]Cook TM, Counsell D, Wildsmith JAW. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists Br J Anaesth, 2009.PMID 19139027
[2]Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition) Reg Anesth Pain Med, 2010.PMID 20052816
[3]Tunn R, Ramakrishnan R, Hartopp R, et al. Neurological complications following obstetric neuraxial anaesthesia: a four-year United Kingdom population-based study of epidural haematoma and epidural abscess (2014-2017) Int J Obstet Anesth, 2025.PMID 40505292
[4]Singh NP, Makkar JK, Khurana BJK, et al. Efficacy and safety of different vasopressor infusions on feto-maternal outcomes in normotensive patients undergoing caesarean delivery: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia, 2026.PMID 41854017
[5]Ladha KS, Kato R, et al. A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 micrograms. Int J Obstet Anesth, 2017.PMID 28964640
[6]Boonmak P, Boonmak S Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev, 2010.PMID 20091522
[7]Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg, 2002.PMID 11916798
[8]Ferré F, Martin C, Bosch L, et al. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth, 2020.PMID 32581577
[9]Palmer CM, Emerson S, Volgoropolous D, Alves D. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology, 1999.PMID 9952150
[10]Sachs A, Smiley R. Post-dural puncture headache: the worst common complication in obstetric anesthesia. Semin Perinatol, 2014.PMID 25146108
[11]Pitkänen M, Rosenberg PH. Local anaesthetics and additives for spinal anaesthesia--characteristics and factors influencing the spread and duration of the block. Best Pract Res Clin Anaesthesiol, 2003.PMID 14529004

Viva Stems

Spinal, epidural or combined spinal-epidural for an elective caesarean — how do you choose?

What determines how high the spinal goes?

Her pressure falls to 85 — talk me through prevention and treatment.

Phenylephrine or ephedrine — defend your choice with numbers.

Day one: severe back pain and weak legs with an epidural in situ. What now?

She is anticoagulated. When can you place and remove the block?

How much intrathecal morphine, and what monitoring?

Postural headache after a wet tap — workup and treatment.

References11Show

[1]Cook TM, Counsell D, Wildsmith JAW. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists Br J Anaesth, 2009.PMID 19139027
[2]Horlocker TT, Wedel DJ, Rowlingson JC, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition) Reg Anesth Pain Med, 2010.PMID 20052816
[3]Tunn R, Ramakrishnan R, Hartopp R, et al. Neurological complications following obstetric neuraxial anaesthesia: a four-year United Kingdom population-based study of epidural haematoma and epidural abscess (2014-2017) Int J Obstet Anesth, 2025.PMID 40505292
[4]Singh NP, Makkar JK, Khurana BJK, et al. Efficacy and safety of different vasopressor infusions on feto-maternal outcomes in normotensive patients undergoing caesarean delivery: a systematic review and network meta-analysis of randomised controlled trials. Anaesthesia, 2026.PMID 41854017
[5]Ladha KS, Kato R, et al. A prospective study of post-cesarean delivery hypoxia after spinal anesthesia with intrathecal morphine 150 micrograms. Int J Obstet Anesth, 2017.PMID 28964640
[6]Boonmak P, Boonmak S Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev, 2010.PMID 20091522
[7]Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg, 2002.PMID 11916798
[8]Ferré F, Martin C, Bosch L, et al. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth, 2020.PMID 32581577
[9]Palmer CM, Emerson S, Volgoropolous D, Alves D. Dose-response relationship of intrathecal morphine for postcesarean analgesia. Anesthesiology, 1999.PMID 9952150
[10]Sachs A, Smiley R. Post-dural puncture headache: the worst common complication in obstetric anesthesia. Semin Perinatol, 2014.PMID 25146108
[11]Pitkänen M, Rosenberg PH. Local anaesthetics and additives for spinal anaesthesia--characteristics and factors influencing the spread and duration of the block. Best Pract Res Clin Anaesthesiol, 2003.PMID 14529004

Neuraxial anaesthesia — Viva

Viva Stems

Neuraxial anaesthesia — Viva

Viva Stems