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Hypotension is the most common complication of neuraxial anesthesia in obstetric patients and
its prevalence in cesarean section is about 50-90%. Maternal hypotension causes unpleasant
symptoms such as nausea, vomiting, loss of consciousness, respiratory depression, and cardiac
arrest. Hypotension may reduce placental perfusion and result in fetal acidosis and
neurological injury. Several techniques have been proposed to prevent hypotension.

The recommended spinal block height to ensure patient comfort for Cesarean delivery is T4-6.
Clinically, it is desirable that the spread of local anesthetic through the cerebrospinal
fluid (CSF) achieves a sensory level no higher than the T4 dermatome to avoid extensive
sympathetic block. It is also important that the spinal block level be no lower than T6 to
avoid patient discomfort during peritoneal manipulation and uterine exteriorization. The
effect of injection speed on spread of spinal anesthesia is controversial. Several studies
have demonstrated more extensive spread with faster injection while others report either
greater spread with slower injection, or no difference. Slow injection of hyperbaric
bupivacaine 10 mg over 60 and 120 sec has been shown to reduce the incidence and severity of
hypotension during Cesarean delivery under spinal anesthesia.