After performing a single-shot intrathecal anaesthetic consisting of 6.5mg of preservative free bupivacaine and 25 ug of fentanyl, the surgical incision is made and systemic hypotension ensued. To avoid significant decrease in uterine blood flow, first-line therapy to consider is
No need to add on nitric oxide,as uterine vasculature is maximally dilated under normal conditions during pregnancy. Trendelenburg position encourages increase in venous return and α-agonists can increase maternal arterial blood pressure.
i.v fluids can thus improve volume status.
Provide additional inhaled nitric oxide to vasodilate the uterine vasculature
Increase maternal cardiac output with use of epinephrine
Increase intravascular volume with fluids
Use reverse Trendelenburg to decrease aortocaval compression