Vasopressor Choice for Spinal Hypotension
CA-2 · I.C.1.a.2.b I.C.1.a.2.c I.C.1.b.2
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Norepinephrine, metaraminol, and mephentermine may have a lower probability of adversely affecting fetal acid-base status (umbilical arterial base excess) compared to phenylephrine during Caesarean delivery under neuraxial anesthesia.
PMID 31810562
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Ranked across 109 trials of spinal anaesthesia for caesarean section, metaraminol, norepinephrine and phenylephrine were the most effective at preventing hypotension, while crystalloid given before induction was no better than control.
PMID 31531852
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Given by infusion, norepinephrine held systolic pressure as well as phenylephrine but with a higher heart rate and cardiac output, lower systemic vascular resistance and less bradycardia.
PMID 25635593
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Using equipotent boluses, bradycardia occurred in 11% with norepinephrine 6 micrograms versus 38% with phenylephrine 100 micrograms, and fewer patients needed rescue ephedrine.
PMID 30113395
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Phenylephrine raises blood pressure while lowering cardiac output, and although it increases cerebral blood flow it decreases cerebral tissue oxygen saturation.
PMID 37948131
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Norepinephrine 8 micrograms is about equivalent to phenylephrine 100 micrograms, a potency ratio near 13 to 1, so the two cannot be swapped at the same numerical dose.
PMID 28872480
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