Skip Navigation LinksHome > June 2012 - Volume 25 - Issue 3 > Caesarean delivery vasopressor management
Current Opinion in Anaesthesiology:
doi: 10.1097/ACO.0b013e3283530d62
OBSTETRIC AND GYNECOLOGICAL ANESTHESIA: Edited by Cynthia A. Wong

Caesarean delivery vasopressor management

Cooper, David W.

Collapse Box

Abstract

Purpose of review: This review assesses the maternal and fetal effects of vasopressor administration during spinal anaesthesia for caesarean delivery, with emphasis on recent findings.

Recent findings: Maternal heart rate is a good surrogate for cardiac output. The initial hypotensive effect of spinal anaesthesia is caused by a rapid decrease in systemic vascular resistance, which makes α-agonists the logical first-line therapy. Effective prophylactic phenylephrine administration can be associated with reduced maternal cardiac output, but this has not been associated with adverse maternal or fetal effects. Prophylactic phenylephrine infusion can cause hypertension if increasing arterial pressure does not trigger a timely reduction in the rate of administration. Phenylephrine has been used safely in mothers with cardiac disease and in pregnancies with suspected fetal compromise. Fetal genotype may increase resistance to ephedrine-induced acidosis. The combination of vagolytics and vasopressors has caused maternal hypertensive crises with serious adverse outcome.

Summary: Phenylephrine is the current vasopressor of choice for the prevention of maternal hypotension and nausea. Phenylephrine regimens need to be developed that can reliably and safely be used with noninvasive blood pressure cycle times less frequent than every minute. Further vasopressor should be used with caution when vagolytic therapy is, quite rightly, used to treat bradycardia associated with hypotension.

© 2012 Lippincott Williams & Wilkins, Inc.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.