Table 2.

Suggested strategies to reduce the risk of failed spinal anesthesia

Adequate dosing of local anesthetic	Increase with low birth weight, <29 weeks of gestation, prophylactic vasopressor infusion
Add intrathecal lipophilic opioid	Fentanyl or Sufentanil
Consider CSE in expected longer surgical duration	Particularly in repeat CD, tubal ligation
Appropriate motor and sensory testing before start of surgery	Consider repeat spinal if no effect at all. Otherwise, consider reduced dose spinal, CSE or change to epidural anesthesia

CD, cesarean delivery; CSE, combined spinal epidural technique.