Canadian Journal of Anesthesia

, Volume 49, Issue 6, pp 588–599 | Cite as

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

Obstetrical and Pediatric Anesthesia

Abstract

Purpose

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.

Source

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.

Principal findings

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 [Cl], 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% Cl, 0.55 to 3.35) or the incidence of low Apgar scores (< 7 or < 8) at one minute (RR, 0.77; 95% Cl, 0.29 to 2.06) and five minutes (RR, 0.72; 95% Cl, 0.24 to 2.19).

Conclusions

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.

L’administration prophylactique d’éphédrine prévient l’hypotension pendant la rachianesthêsie pour Césarienne, mais n’améliore pas l’évolution néonatale : une revue méthodique quantitative

Résumé

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.

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 : spinal anesthesia, hypotension, Cesarean section, pregnancy complications, pregnancy outcome, fetal outcome, neonatal outcome, umbilical blood cord gases, vasopressor et ephedrine. Nous n’avons considéré que les essais cliniques qui comparaient l’éphédrine prophylactique à un témoin, sans égard à la dose et à la voie d’administration.

Constatations principales

Les 14 essais cliniques retenus comportaient des données sur 641 patientes. Léphédrine a été plus efficace que le médicament témoin dans la prévention de l’hypotension (risque relatif [RR], 0,73 ; intervalle de confiance [IC] de 95 %, 0,63 à 0,86). Le plus important est l’absence de différence de risque d’acidose fœtale, définie par un pH de l’artère ombilicale < 7,2 (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).

Conclusion

Ladministration préventive d’éphédrine agit plus efficacement qu’un médicament témoin contre l’hypotension pendant la rachianesthésie pour Césarienne, mais aucun effet positif de pertinence clinique sur l’évolution néonatale n’est observé. Notre revue systématique ne corrobore donc pas l’usage courant d’éphédrine prophylactique comme prévention de tout effet indésirable sur l’hypotension maternelle suivant la rachianesthésie pendant la césarienne.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive CareThe Chinese University of Hong Kong, Prince of Wales HospitalHong KongChina

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