Intraoperative hypotension, a recognized risk factor for perioperative morbidity and mortality, is a notable concern in clinical practice. While spinal anesthesia is a frequently employed technique known for its capacity to mitigate the surgical stress response, enhance postoperative oxygenation, and reduce the incidence of postoperative pulmonary complications and deep vein thrombosis, it is, however, also associated with a significant drawback: the propensity to induce hypotension.

 Various preventive measures are recommended to address this hypotension, including the use of vasopressor medications, administering fluids, and positioning the patient on their left side. Overly aggressive treatment with vasopressors and fluids can lead to other circulatory complications like hypertension, bradycardia, tachycardia, arrhythmia, and even pulmonary edema.

Transthoracic echocardiography (TTE) is commonly employed in the operating room for real-time assessment of patients with unstable hemodynamic and to predict fluid responsiveness. For spontaneously breathing patients, changes in the velocity-time integral (VTI) of the left ventricular outflow tract induced by a passive leg raise (PLR) is an innovative tool and can accurately predict fluid responsiveness.

 In our study we focus on preloading, to address the challenge of optimal fluid administration, point of care ultrasound is used to detect cardiac parameters.