The use of vasopressors during spinal anaesthesia for caesarean section.

@article{NganKee2017TheUO,
  title={The use of vasopressors during spinal anaesthesia for caesarean section.},
  author={Warwick D Ngan Kee},
  journal={Current Opinion in Anaesthesiology},
  year={2017}
}
  • W. N. Ngan Kee
  • Published 2017
  • Medicine
  • Current Opinion in Anaesthesiology
PURPOSE OF REVIEW Hypotension remains one of the most researched subjects in obstetric anaesthesia. The purpose of this study is to review the most recent published articles on the use of vasopressors during spinal anaesthesia for caesarean section. RECENT FINDINGS Despite continued research indicating advantages of phenylephrine over ephedrine, practitioners in some countries continue to favour ephedrine. Recent research has continued to compare the two drugs with some work emerging on high… 
Management of hypotension with vasopressors at caesarean section under spinal anaesthesia – have we found the Holy Grail of obstetric anaesthesia?
TLDR
It is surprising that management of spinal-induced hypotension for caesarean section continues to be highly variable, despite the outcomes of many well-performed clinical trials and recommendations from several review articles and editorials advocating phenylephrine as the vasopressor of choice.
A Comparative Study to Evaluate the Effect of Norepinephrine and Phenylephrine in the Treatment of Post Spinal Hypotension for Caesarean Section
TLDR
Intermittent boluses of norepinephrine were effective in the treatment of spinal anaesthesia induced hypotension during caesarean section and can be considered as an alternative to phenylephrine.
Norepinephrine and Etilefrin as prevention of maternal hypotension in cesarean section under spinal anesthesia
TLDR
The use of norepinephrine in infusion compared to etilefrine is effective because the hemodynamic variables were better controlled at a very low cost for the management of maternal hypotension after spinal anesthesia.
Effectiveness of Intravenous Prophylactic Phenylephrine for the Prevention of Spinal Anaesthesia Induced Hypotension during Caesarean Section. A Prospective Observational Study
TLDR
Prophylactic intravenous phenylephrine bolus remarkably reduced the incidence of spinal induced hypotension compared to the non-treatment group and is recommended for parturients undergoing caesarean section under spinal anaesthesia.
Norepinephrine versus ephedrine for hypotension prophylaxis during cesarean section under spinal anesthesia
TLDR
Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.
The impact of fluid optimisation before induction of anaesthesia on hypotension after induction
TLDR
Treatment of hypotension seems to be a matter of balance between administration of fluids and vasopressors, which clearly support the pre-emptive administration of a vasopressor early in the induction phase and throughout surgery in this patient population.
Comparison of two vasopressor protocols for preventing hypotension post-spinal anesthesia during cesarean section: a randomized controlled trial
TLDR
In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.
Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia.
TLDR
Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95%) µg/kg/min, respectively.
A randomised dose-response study of prophylactic Methoxamine infusion for preventing spinal-induced hypotension during Cesarean delivery
TLDR
Under the conditions of this study, when prophylactic methoxamine infusion was given at a fixed-rate based on body weight for preventing spinal-induced hypotension in obstetric patients, the values for ED 50 and ED 95 were 2.178 and 4.821 μg/kg/min respectively.
Crystalloid coloading vs. colloid coloading in elective Caesarean section: postspinal hypotension and vasopressor consumption, a prospective, observational clinical trial
TLDR
Crystalloid coloading was associated with a greater drop in mean blood pressure and a higher incidence of hypotension when compared with colloids, and neonatal outcome was, however, unaffected by the type of fluid.
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References

SHOWING 1-10 OF 38 REFERENCES
Vasopressors in obstetrics: what should we be using?
TLDR
When current evidence is considered, in the authors' opinion, phenylephrine is the vasopression that most closely meets the criteria for the best vasopressor in obstetrics.
Norepinephrine for Spinal Hypotension during Cesarean Delivery: Another Paradigm Shift?
TLDR
A double-blinded, randomized clinical trial comparing norepinephrine and phenylephrine infusion for the maintenance of blood pressure during cesarean delivery under spinal anesthesia found that a computercontrolled infusion of norpinephrine maintained blood pressure as effectively as phenyle cortisol, but with less bradycardia and less decrease in cardiac output.
Phenylephrine infusions for maintaining blood pressure during spinal anesthesia for cesarean delivery: finding the shoe that fits.
TLDR
Patients who received a phenylephrine infusion had less hypotension, less nausea/vomiting, and similar neonatal outcome compared with control, and a randomized double-blinded study showed that good blood pressure control is indeed achievable with intermittent boluses.
A comparison of three vasopressors for tight control of maternal blood pressure during cesarean section under spinal anesthesia: Effect on maternal and fetal outcome
TLDR
All the three vasopressors were equally effective in maintaining maternal blood pressure as well as umbilical pH during spinal anesthesia for cesarean section without any detrimental effects on fetal and maternal outcome.
Ephedrine for spinal hypotension during elective caesarean section: the final nail in the coffin?
TLDR
The thorough analysis in Acta Anaesthesiologica Scandinavica this month clearly shows that ephedrine, when used for the treatment of spinal hypotension, is associated with a higher incidence of true foetal acidosis than phenylephrine, and there is still some doubt as to whether the level of acidosis associated with pre-delivery ephedine use is of clinical significance.
A randomised controlled trial comparing weight adjusted dose versus fixed dose prophylactic phenylephrine infusion on maintaining systolic blood pressure during caesarean section under spinal anaesthesia.
TLDR
Among this population, the incidence of hypotension was significantly less in the weight adjusted dose group than in the fixed dose group, and the difference in the incidence rates between the two groups was found to be statistically significant p= 0.03.
Preventing spinal hypotension during Caesarean delivery: what is the latest?
TLDR
This editorial aims to highlight key research findings pertaining to vasopressor regimens and how these regimens can be incorporated into clinical practice.
Retrospective comparison of ephedrine and phenylephrine for the treatment of spinal anesthesia induced hypotension in pre-eclamptic patients
TLDR
It is found that there is no difference in neonatal umbilical artery pH between ephedrine and phenylephrine when used to treat spinal anesthesia induced hypotension during cesarean delivery in pre-eclamptic patients.
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