Questions · Vasopressors for Cesarean Spinal Hypotension
9 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
In a Bayesian network meta-analysis of 52 trials of vasopressors for caesarean delivery, ranked on umbilical arterial base excess, which agents were least likely to worsen fetal acid-base status, and which agent performed worst?
Answer: Ranked on umbilical arterial base excess, norepinephrine, mephentermine and metaraminol were least likely to worsen fetal acid-base status, and ephedrine was the worst agent for nearly every outcome.
If you are choosing with the cord gas in mind, ephedrine is the agent this analysis ranked worst on nearly every outcome.
Source claim: 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.
Vasopressor Drugs for the Prevention and Treatment of Hypotension During Neuraxial Anaesthesia for Caesarean Delivery: A Bayesian Network Meta-Analysis of Fetal and Maternal Outcomes, British journal of anaesthesia 2020
recall · CA-2 · phrased by llm
For spinal anaesthesia for caesarean section, which vasopressor does the review evidence support as first line, and does it favour a prophylactic infusion or intermittent boluses?
Answer: The evidence continues to support phenylephrine as the first-line obstetric vasopressor, and prophylactic infusions are more effective and require less intervention than intermittent boluses.
Start the prophylactic infusion with the spinal rather than chasing the pressure with boluses — it is more effective and needs less intervention.
Source claim: Evidence continues to support phenylephrine as the first-line obstetric vasopressor, with prophylactic infusions more effective and requiring less intervention than intermittent boluses.
The Use of Vasopressors During Spinal Anaesthesia for Caesarean Section, Current opinion in anaesthesiology 2017
recall · CA-1 · phrased by llm
A colleague states that norepinephrine has been shown to be superior to phenylephrine for caesarean spinal hypotension. Based on the systematic review of 13 trials, how should you characterise the evidence, including what that review could not rule out?
Answer: The systematic review of 13 trials found the evidence still too limited to establish an advantage of norepinephrine over phenylephrine, and it could not fully rule out an effect on fetal blood gas status, so superiority has not been established.
Thirteen trials in, 'no established advantage' is not the same as proven equivalence — an effect on fetal blood gas status was not fully excluded.
Source claim: 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.
A Systematic Review of Phenylephrine vs. Noradrenaline for the Management of Hypotension Associated With Neuraxial Anaesthesia in Women Undergoing Caesarean Section, Anaesthesia 2020
recall · CA-3 · phrased by llm
Across 15 trials of norepinephrine versus phenylephrine for post-spinal hypotension in parturients having caesarean section, how did the two agents compare for treating the hypotension, what was the effect on maternal bradycardia, and how strong was that bradycardia evidence?
Answer: Across those 15 trials norepinephrine and phenylephrine were equally effective for post-spinal hypotension, but norepinephrine reduced maternal bradycardia by 61%, and that reduction rested on high-quality evidence.
Equally effective on the pressure, better on maternal heart rate — the 61% reduction in bradycardia is the high-quality part of this comparison.
Source claim: Across 15 trials, norepinephrine and phenylephrine were equally effective for post-spinal hypotension, but norepinephrine reduced maternal bradycardia by 61% on high-quality evidence.
Norepinephrine Versus Phenylephrine for Postspinal Hypotension in Parturients Undergoing Cesarean Section: A Systematic Review and Meta-Analysis, Minerva anestesiologica 2022
recall · CA-2 · phrased by llm
As equipotent boluses, norepinephrine 6 micrograms produced bradycardia in ___% versus 37.5% with phenylephrine 100 micrograms, and fewer patients needed rescue ephedrine.
Answer: 10.7
As equipotent boluses, norepinephrine 6 micrograms produced bradycardia in 10.7% versus 37.5% with phenylephrine 100 micrograms, and fewer patients needed rescue ephedrine.
Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial · PMID 30113395
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.