SynthesisBMC anesthesiology2024
Comparison of vasopressors for management of hypotension in high-risk caesarean section under neuraxial anesthesia: a systematic review and network meta-analysis.
Synthesis in BMC anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Clinical practices in general anaesthesia for caesarean section: A nationwide cross-sectional survey.European journal of anaesthesiology and intensive care · 2026Article
- Hemodynamic Changes During Cesarean Section Under Spinal Anesthesia in Normotensive and Hypertensive Pregnant Women-A Narrative Review.Journal of clinical medicine · 2026Review
- Prevention of post-spinal hypotension in high risk cesarean delivery: A systematic review and updated network meta-analysis of prophylactic vasopressor infusions.Indian journal of anaesthesia · 2026Article
- Comparison of Two Different Norepinephrine Bolus Doses for Management of Spinal Anesthesia-Induced Maternal Hypotension in Cesarean Section: A Double-Blind Randomized Controlled Study.Journal of clinical medicine · 2025Article
- Dissecting Vasopressor Efficacy in the Management of Maternal Hypotension in Preeclamptic Cesarean Delivery: A Systematic Review of Randomized Controlled Trials.Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2025Article
- Review
- Difficult airway management in a patient with severe mitral and tricuspid regurgitation, rapid atrial fibrillation, and moderate pulmonary hypertension: a case report.BMC anesthesiology · 2025Article
- Feasibility of continuous high-resolution bioreactance monitoring during cesarean delivery under spinal anesthesia.Frontiers in medicine · 2025Article
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Authors and funding
5 authors.
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Abstract
backgroundVasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation.
methodsWe compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models.
resultsWe analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable.
conclusionsOur findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery.
trial registrationThis systematic review was registered at PROSPERO (CRD42023397259).
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