Authors: Velusamy K, Kumar A, Kumar S, et al.
Cureus 17(8): e90770, August 2025. doi:10.7759/cureus.90770
This prospective observational study evaluated the relationship between cerebral oxygenation and post-spinal hypotension in 86 full-term parturients undergoing cesarean section under spinal anesthesia. Cerebral regional oxygen saturation (C-rSO₂) was continuously monitored using near-infrared spectroscopy (NIRS), while mean blood pressure (MBP) was recorded every minute. Neonatal outcomes were assessed with Apgar scores and cord blood analysis, and maternal cognition was evaluated for postoperative delirium.
The findings showed that the decline in cerebral oxygenation did not correlate directly with the fall in MBP. Importantly, decreases in C-rSO₂ occurred earlier than the maximal fall in MBP, suggesting NIRS may serve as an earlier predictor of hypotension compared with intermittent blood pressure monitoring. Both vasopressors maintained MBP within 20% of baseline, but ephedrine proved superior to phenylephrine in improving cerebral oxygenation. No significant adverse effects were observed in neonatal Apgar scores, acid-base balance, or maternal postoperative cognition.
What you should know:
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Cerebral oxygen desaturation occurred earlier than measurable MBP decline, making NIRS a useful predictor of hypotension.
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No direct correlation was found between the magnitude of MBP fall and cerebral oxygenation decrease.
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Ephedrine improved maternal cerebral oxygenation more effectively than phenylephrine.
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Neonatal outcomes (Apgar scores, acid-base status) were unaffected by maternal hypotension if corrected promptly.
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No maternal postoperative delirium was observed.
Thank you to Cureus for publishing this important study on maternal cerebral oxygenation and neonatal safety during spinal anesthesia for cesarean delivery.