D23 Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Groote Schuur Hospital, Anzio Road, Observatory 7925, Cape Town, South Africa.
Department of Anaesthesiology and Critical Care, University of KwaZulu-Natal, South Africa; Department of Anaesthesia, Critical Care and Pain Management, University of KwaZulu-Natal, Grey's Hospital, Town Bush Road, Pietermaritzburg, 3201, South Africa.
Best Pract Res Clin Anaesthesiol. 2022 May;36(1):69-82. doi: 10.1016/j.bpa.2022.04.001. Epub 2022 Apr 12.
Spinal hypotension during caesarean section remains a common complication, with important attendant maternal and fetal adverse outcomes. Research elucidating the mechanisms of spinal hypotension has led to the development and refinement of effective management strategies, with a particular emphasis on prophylactic vasopressor administration. This has proved effective in well-resourced settings, with maternal comfort and the elimination of nausea now considered the primary aim of treatment. In resource-limited settings, sophisticated strategies are not feasible due to insufficient equipment, staff, and expertise. Therefore, in these areas spinal hypotension remains an important cause of maternal and fetal morbidity and mortality. Translational, context-sensitive research in resource-limited settings has shown promise in implementing pragmatic strategies based on research from resource-rich environments. We review the current best practice for the prevention and treatment of spinal hypotension, with a special emphasis on effective strategies in resource-limited settings. We further suggest a research agenda to address the knowledge gap in specific contexts.
剖宫产术中的脊髓低血压仍然是一种常见的并发症，会导致产妇和胎儿出现严重不良后果。对脊髓低血压发生机制的研究促进了有效管理策略的制定和完善，尤其是预防性血管加压素的应用。在资源充足的环境中，这种策略非常有效，目前的主要治疗目标是产妇的舒适度和恶心的消除。在资源有限的环境中，由于设备、人员和专业知识不足，复杂的策略并不可行。因此，在这些地区，脊髓低血压仍然是产妇和胎儿发病率和死亡率的重要原因。在资源有限的环境中进行的具有转化意义、针对具体情况的研究表明，基于资源丰富环境的研究来实施实用策略具有前景。我们综述了预防和治疗脊髓低血压的当前最佳实践，特别强调了资源有限环境中的有效策略。我们还提出了一个研究议程，以解决特定环境中的知识差距。
