Fluid Therapy as Prevention of Hypotension Induced by Subarachnoid Anesthesia in Cesarean Section

Abstract

The anesthetic technique of choice for caesarean section is spinal anesthesia. Hypotension is the most frequent adverse effect of this anesthetic technique and is related to maternal and fetal deleterious effects that can cause serious complica- tions. For this reason, it is important to know the complications and the therapeutic approach of maternal hypotension, in order to reduce the morbidity and mortality of the maternal-fetal binomial. There are several measures to reduce maternal hypotension after subarachnoid block, both in the number of cases and in its severity, but fluid loading has become the cornerstone in hypotension prophylaxis. There are various alternatives for the prevention and management of arterial hypotension; one of them fluid therapy. The objective of this review is to evaluate the recent evidence available for the different fluid therapy alternatives and to evaluate their effectiveness in their different modalities (pre-loading with colloids or crystalloids, co-loading with colloids or crystalloids), none of which seems to be fully effective as monotherapy. The approach to the prevention and treatment of hypotension should be multimodal. Due to its availability and safety of use, to date, co-loading with crystalloids associated with alpha agonist vasopressor therapy seems to be the best alternative.