Severe Spinal Hypotension Refractory — FRCA Final MCQ

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HardRegional AnaesthesiaSevere Spinal Hypotension RefractoryFRCA Final

A 75-year-old woman receives spinal anaesthesia. 5 min later: HR 38, BP 62/35. After atropine 600 mcg IV with no improvement, next intervention?

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Correct answer: A — Adrenaline 50 mcg IV

Severe spinal-induced cardiovascular collapse refractory to atropine: small-dose IV adrenaline (10-50 mcg) for both vasopressor and chronotropic effects. Phenylephrine worsens bradycardia via baroreceptor reflex. Ephedrine less reliable in severe cases.

Reference: Association of Anaesthetists – 2023 – QRH: Cardiovascular collapse under spinal