Intraoperative neuromonitoring in cardiac surgical patients with severe cerebrovascular disease.

hypotension occurs during spinal anesthesia. Only one prior case has been published describing profound hypotension in a parturient with bipolar disease, controlled with lithium and risperidone, undergoing spinal anesthesia for Cesarean delivery. The patient was refractory to conventional treatment with ephedrine and iv fluids, and eventually responded to large doses of phenylephrine.2 The treatment should consist of iv fluids and sympathomimetic drugs. Epinephrine and dopamine are not recommended, as ß-stimulation may worsen hypotension due to risperidone-induced α-adrenergic antagonism.