Recipes for obstetric spinal hypotension: The clinical context counts.
Hypotension following obstetric spinal anaesthesia remains a common and important problem. While recent research advances have brought us closer to the perfect recipe for the obstetric spinal anaesthetic, these advances have not been translated into practical guidelines able to reduce the unacceptable number of fatalities that occur in environments where resources are limited. In South Africa, more than half of anaesthetic deaths are still related to spinal hypotension. A gap exists between the 'perfect recipe', developed from a clinical context rooted in resource-rich research environments, and its application and performance in real-world resource-poor environments - conditions experienced by more than 75% of the world's population. This review attempts to define this knowledge gap and proposes a research agenda to address the deficiencies.
Perioperative Research Group, Department of Anaesthetics, Edendale Hospital, Pietermaritzburg, South Africa, and School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa. davidgbishop@gmail.com.
David G
DG
Bishop
Reitze N
RN
Rodseth
Robert A
RA
Dyer
D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000379:methods; D000777:Anesthetics / Q000009:adverse effects / Q000145:classification / Q000494:pharmacology; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic
D000777:Anesthetics