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Update on Vasopressors for Cesarean Delivery

  • Obstetric Anesthesia (LR Leffert, Section Editor)
  • Published:
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Abstract

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.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Department of Anaesthetics, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Portsmouth Rd, Frimley, Camberley, Surrey, GU16 7UJ, UK

    Stephen Ramage & Sarah Armstrong

  2. Department of Anesthesia and Perioperative Medicine, The Women’s Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar

    Roshan Fernando

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  1. Stephen Ramage
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Ramage, S., Armstrong, S. & Fernando, R. Update on Vasopressors for Cesarean Delivery. Curr Anesthesiol Rep 9, 39–47 (2019). https://doi.org/10.1007/s40140-019-00315-2

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