Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review

Abstract

P Pu ur rp po os se e: : The objective of this systematic review was to assess the effectiveness and safety of ephedrine compared with control when given prophylactically to prevent hypotension during spinal anesthesia for Cesarean delivery.S So ou ur rc ce e: : Randomized, controlled trials obtained through MEDLINE, EMBASE, the Cochrane Controlled Trials Registry, contact with leading experts, and a reference list of published articles were analyzed. The following keywords were utilized: spinal anesthesia, hypotension, Cesarean section, pregnancy complications, pregnancy outcome, fetal outcome, neonatal outcome, umbilical blood cord gases, vasopressor and ephedrine. Clinical trials were considered if they compared prophylactic ephedrine, given by any dose or route, vs control. P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : The 14 clinical trials identified included data from a total of 641 patients. Ephedrine was more effective than control for preventing hypotension (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63 to 0.86). Most importantly, there was no difference in the risk of fetal acidosis, defined as umbilical arterial pH < 7.2 (RR, 1.36; 95% CI, 0.55 to 3.35) or the incidence of low Apgar scores (< 7 or < 8) at one minute (RR, 0.77; 95% CI, 0.29 to 2.06) and five minutes (RR, 0.72; 95% CI, 0.24 to 2.19).C Co on nc cl lu us si io on ns s: : Prophylactic ephedrine is more effective than control for preventing hypotension during spinal anesthesia for elective Cesarean delivery but a clinically relevant positive effect on neonatal outcome was not observed. Therefore, the routine use of prophylactic ephedrine to prevent any adverse effects of maternal hypotension following spinal anesthesia for Cesarean delivery is not supported by the current systematic review.Objectif : Évaluer l'efficacité et l'innocuité de l'éphédrine, comparée à un témoin, administrée de manière prophylactique pour prévenir l'hypotension pendant la rachianesthésie lors de l'accouchement par Césarienne. (RR,1,36 ; IC de 95 %, 0,55 à 3,35) ou l'incidence d'indice d'Apgar < 7 ou < 8 à une minute (RR, 0,77 ; IC 95 %, 0,29 à 2,06) et à cinq minutes (RR, 0,72 ; IC 95 %, 0,24 à 2,19 Source : Nous avons analysé des essais randomisés et contrôlés obtenus de MEDLINE, EMBASE, l'Index Cochrane des essais randomisés et contrôlés, personnes-ressources autorisées et une liste de références d'articles publiés. Les mots clés ont été

Effect of leg wrapping on haemodynamics and associated complications in caesarean section: a randomised prospective study

“…During spinal anesthesia relaxation of calf muscles due to sympathetic blockade leads to loss of pumping action of calf muscles and the vascular distensibility of the calf vessels has been shown to increase by 17%. 9 Leg elevation alone or in combination with leg wrapping might cause cephalic displacement of hyperbaric solution due to flattening of the lumber curvature of the spine resulting in a higher level of sensory, motor and sympathetic blockade. Parturients at term have more blood trapped in the lower extremities and spinal anesthesia induced vasodilatation will increase the pooling of blood even more.…”

Solving the problem of spinal-induced hypotension in obstetric anesthesia

“…1 Unfortunately the review does not hand us the "Holy Grail" of obstetric anesthesia -an infallible technique to prevent spinal anesthesiainduced hypotension. We can however, reflect upon the scientific study of this topic and re-evaluate our clinical approach to this problem.…”

“…1 Malheureusement, elle ne nous livre pas le "Saint-Graal" de l'anesthésie EDITORIAL obstétricale, à savoir une technique infaillible pour prévenir l'hypotension induite par la rachianesthésie. Nous pouvons toutefois rendre compte de l'étude scientifique du sujet et réévaluer notre vision clinique du problème.…”

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