with a PMH of migraines and RCVSx2 complicated by a
subarachnoid hemorrhage (SAH)
 Arrived for an elective Cesarean Section
 The goal was to avoid vasoactive medications due to the patient's history of RCVS,
and measures were taken to proactively manage spinal anesthesia-induced
hypotension.
 In addition to standard ASA monitors, a noninvasive finger cuff (Edwards
ClearSightSystem) was used for continuous noninvasive hemodynamic monitoring.
 The patient received 500ml of 5% albumin before intrathecal injection and 500ml
bolus of Lactated Ringer's as a co-load.
 After an uneventful spinal block, patient was placed in a 30°left lateral tilt and the
Trendelenburg position.
 During the case, the patient additionally received 250 ml of 5% Albumin and 1000
ML of LR.
 The patient remained hemodynamically stable throughout the procedure, and no
vasoactive medications were used.

Discussion.
 (RCVS) presentation varies widely and can include: isolated
severe thunderclap headaches, with full recovery in most
patients.
 Rare instances of permanent brain injury, which may be
related to intracerebral hemorrhage, cerebral edema, stroke,
seizure, and even death.
 Reversible cerebral vasoconstriction syndrome (RCVS) can
occur spontaneously, but up to 80% of individuals with RCVS
experience identifiable trigger factors, such as pregnancy or
exposure to vasoactive substances (e.g., triptans, ergots,
NSAIDs, and vasopressors).
 Pregnant patients with RCVS who undergo a spinal block for
the Cesarean Section pose a unique challenge for an
anesthesiologist as use of vasoactive drugs (Phenylephrine)
has become standard practice to manage post-spinal
hypotension.
 There are no guidelines published on post-spinal hypotension
management in patients with RCVS, although avoiding
vasopressors is recommended.
 The authors report their experience in managing post-spinal
hypotension without vasoactive medications in a patient with
RCVS who underwent spinal anesthesia for Cesarean Section.