Does ephedrine influence newborn neurobehavioural responses and spectral EEG when used to prevent maternal hypotension during caesarean section?

Abstract

The recovery of 16 infants born by elective caesarean section with spinal anaesthesia, in which either ephedrine or fluid load was used to prevent maternal hypotension, were studied using Scanlon's neurobehavioural tests and a computerized EEG. Neurobehavioural testing showed no differences between the ephedrine and the non-ephedrine groups of infants at ages of 3 h, 1 day, 2 days and 4-5 days, whereas the spectral EEG showed significant differences between the two groups during the first 2 h after delivery, which had disappeared 24 h later. It is suggested that small doses of ephedrine given to the mother i.v. to prevent hypotension during spinal anaesthesia have short-lived effects on the neonate's central nervous system, which will be detected in the spectral EEG, but not in neurobehavioural tests.

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

“…In restricting the metaanalysis to only trials that had adequate allocation concealment 1,4,5,26 the overall RR was 0.69 (95% CI, 0.58 to 0.83) with no evidence of heterogeneity (Q statistic = 2.04, df = 3, P = 0.56). In trials where allocation concealment was unclear, 6,7,11,21,24,25,27 the overall RR was 0.76 (95% CI, 0.59 to 0.99) with no evidence of heterogeneity (Q statistic = 11.50; df = 7; P = 0.12).…”

“…Sensitivity analysis performed after excluding Gutsche's trial 7 because of uncertainty about randomization showed that the overall summary effect size was robust (RR, 0.74; 95% CI, 0.65 to 0.85). Another sensitivity analysis performed after exclusion of the trial by Kangas-Saarela et al 27 in which ephedrine was not given unless there was any decrease in arterial pressure to less than the baseline, showed that the overall RR was 0.73 (95% CI, 0.61 to 0.86). Kangas-Saarela et al 27 showed that there was no difference between giving ephedrine or fluid intervention for the prevention of hypotension (RR,1.00; 95% CI, 0.37 to 2.73).…”

“…1,[4][5][6][7]11,[21][22][23][24][25][26] The authors administered ephedrine before spinal anesthesia in three trials, 7,21,24 during induction of spinal anesthesia in one trial 6 and immediately after induction of spinal anesthesia in other trials. 1,4,5,11,22,23,[25][26][27] In one trial, ephedrine was given immediately after there was any decrease in arterial pressure to less than the baseline. 27 In all trials, "rescue" doses of ephedrine were given if hypotension developed (Table).…”

“…1,4,5,11,22,23,[25][26][27] In one trial, ephedrine was given immediately after there was any decrease in arterial pressure to less than the baseline. 27 In all trials, "rescue" doses of ephedrine were given if hypotension developed (Table).…”

“…There were no reports of trials recruiting women undergoing emergency Cesarean delivery, and therefore, we have assumed that all trials included in this systematic review involved women undergoing elective Cesarean delivery. Drugs used for spinal anesthesia included tetracaine, 7,21,22 bupivacaine, 5,6,27 and hyperbaric bupivacaine. 1,4,11,[23][24][25][26] The combined spinal-epidural anesthesia technique was used in two trials.…”