Update on Vasopressors for Cesarean Delivery
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Purpose of Review
The aim of this article is to provide an overview of the current strategies for managing spinal-induced hypotension during cesarean delivery with a particular focus on the evidence guiding the use of vasopressors.
Phenylephrine is currently regarded as the first-line vasopressor in the prevention and treatment of spinal-induced hypotension following evidence that supports a favorable effect on neonatal acid-base status as well as reduced incidences of nausea and vomiting when compared with ephedrine. Norepinephrine and metaraminol are also effective in the prevention and treatment of hypotension.
The current consensus for vasopressor use in the treatment of spinal-induced hypotension has been shaped by data gathered from studies involving healthy parturients undergoing elective cesarean deliveries. While these results cannot necessarily be extrapolated to high-risk patients with impaired cardiovascular function or evidence of fetal compromise, these studies may help inform vasopressor choice and establish recommendations for clinical practice.
KeywordsVasopressor Spinal anesthesia Hypotension Cesarean delivery Aortocaval compression
Compliance with Ethical Standards
Conflict of Interest
Stephen Ramage, Sarah Armstrong, and Roshan Fernando declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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