How can spinal anesthesia-induced hypotension be prevented and managed intraoperatively?

• A. Preload with IV fluids, maintain euvolemia, and use vasopressors as needed; administer epidural or spinal vasopressors
• B. Avoid fluids to prevent overload
• C. Use vasopressors alone without fluids
• D. Delay treating hypotension until after surgery ends

Answer: (A)

Spinal anesthesia blocks sympathetic nerves, causing widespread vasodilation and pooling of blood in the venous capacitance vessels, which reduces venous return to the heart and drops blood pressure. The best way to prevent and manage this intraoperatively is to keep circulating volume adequate and support vascular tone. Preloading or coloading with IV fluids helps maintain preload, and aiming for euvolemia—avoiding both under- and over-resuscitation—prevents exaggerated hypotension without causing fluid overload. When hypotension does occur, promptly using vasopressors to restore systemic vascular resistance and MAP is essential. Commonly used agents are administered intravenously as needed, with the goal of maintaining stable hemodynamics throughout the case. In some protocols, neuraxial (intrathecal or epidural) vasopressors have been explored to blunt the drop in pressure, but the core management remains IV fluids and IV vasopressors.