Vasopressors for Cesarean Spinal Hypotension
CA-2 ·
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Ranked on umbilical arterial base excess across 52 trials, norepinephrine, mephentermine and metaraminol were least likely to worsen fetal acid-base status, and ephedrine was the worst agent for nearly every outcome.
PMID 31810562
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During spinal anesthesia for cesarean delivery, norepinephrine infusion maintains systolic blood pressure while causing less bradycardia and greater heart rate and cardiac output compared to phenylephrine.
PMID 25635593
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Evidence continues to support phenylephrine as the first-line obstetric vasopressor, with prophylactic infusions more effective and requiring less intervention than intermittent boluses.
PMID 28277383
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A systematic review of 13 trials found the evidence still too limited to establish an advantage of norepinephrine over phenylephrine, and could not fully rule out an effect on fetal blood gas status.
PMID 32012226
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As equipotent boluses, norepinephrine 6 micrograms produced bradycardia in 10.7% versus 37.5% with phenylephrine 100 micrograms, and fewer patients needed rescue ephedrine.
PMID 30113395
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Across 15 trials, norepinephrine and phenylephrine were equally effective for post-spinal hypotension, but norepinephrine reduced maternal bradycardia by 61% on high-quality evidence.
PMID 35785931
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