Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies

Okudaira, Sayaka; Suzuki, Shunji

doi:10.1007/s00404-003-0594-6

Cited by 22 publications

(15 citation statements)

References 12 publications

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“…Clinical data have largely come from observational studies that separated groups with and without hypotension, or assessed duration of hypotension. Neonates of women with spinal‐induced hypotension had significant acidosis , and hypotension of more than 2 min duration was associated with a significant increase in umbilical venous oxypurines and lipid peroxides, suggestive of ischaemia–reperfusion injury .…”

Section: Consequences Of Hypotension and Its Pharmacological Treatmentmentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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Why was this consensus statement developed?Advances in clinical practice are sometimes inhibited by a multitude of different options that need to be selected. There has been significant variation in the treatment of spinal anaesthesia-induced hypotension. These guidelines are designed to provide clinicians with specific best-practice plans that will cover a wide range of drug and equipment availability. Detailed recommendations are provided for the management of hypotension in resource-rich and resource-poor environments.

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Section: Consequences Of Hypotension and Its Pharmacological Treatmentmentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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“…Surrogate markers of fetal well-being, such as fetal acid-base and oxidative status, have been shown to correlate with the degree and duration of hypotension. 2,3 The mainstay of management of hypotension in this setting is the use of vasopressors, which are highly effective in both the prevention and treatment of hypotension. 4,5 Yet, given the variety of different agents available internationally, the optimal choice of agent in any given setting is unclear.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes

Singh

Singh²,

Reschke

et al. 2020

British Journal of Anaesthesia

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Background: The optimal choice of vasopressor drugs for managing hypotension during neuraxial anaesthesia for Caesarean delivery is unclear. Although phenylephrine was recently recommended as a consensus choice, direct comparison of phenylephrine with vasopressors used in other healthcare settings is largely lacking. Therefore, we assessed this indirectly by collating data from relevant studies in this comprehensive network meta-analysis. Here, we provide the possible rank orders for these vasopressor agents in relation to clinically important fetal and maternal outcomes. Methods: RCTs were independently searched in MEDLINE, Web of Science, Embase, The Cochrane Central Register of Controlled Trials, and clinicaltrials.gov (updated January 31, 2019). The primary outcome assessed was umbilical arterial base excess. Secondary fetal outcomes were umbilical arterial pH and PCO 2. Maternal outcomes were incidences of nausea, vomiting, and bradycardia. Results: We included 52 RCTs with a total of 4126 patients. Our Bayesian network meta-analysis showed the likelihood that norepinephrine, metaraminol, and mephentermine had the lowest probability of adversely affecting the fetal acidbase status as assessed by their effect on umbilical arterial base excess (probability rank order: norepinephrine > mephentermine > metaraminol > phenylephrine > ephedrine). This rank order largely held true for umbilical arterial pH and PCO 2. With the exception of maternal bradycardia, ephedrine had the highest probability of being the worst agent for all assessed outcomes. Because of the inherent imprecision when collating direct/indirect comparisons, the rank orders suggested are possibilities rather than absolute ranks. Conclusion: Our analysis suggests the possibility that norepinephrine and metaraminol are less likely than phenylephrine to be associated with adverse fetal acid-base status during Caesarean delivery. Our results, therefore, lay the scientific foundation for focused trials to enable direct comparisons between these agents and phenylephrine.

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“…Neonates born to mothers with spinal anaesthesia-induced hypotension were significantly more acidotic ( 20 ). Hypotension lasting longer than 2 minutes was connected with a significant increase in oxypurines and lipid peroxides in the umbilical vein, which is indicative of an ischaemia-reperfusion injury ( 21 ). The duration of hypotension plays a more important role than its severity.…”

Section: Definition Of Spinal Anaesthesia-induced Hypotensionmentioning

confidence: 99%

Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy

Šklebar¹,

Bujas

Habek

2019

ACC

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Regional centro-axial anaesthesia, primarily spinal block, is the preferred method of anaesthesia for elective caesarean section because it entails fewer risks for the mother and the foetus compared to general anaesthesia. The most common side effect associated with spinal block is hypotension due to sympatholysis, occurring in up to 75% of cases. Spinal block-induced sympatholysis leads to vasodilatation and consequently causes maternal hypotension, which may compromise uterine blood flow and foetal circulation, and thus cause foetal hypoxia, bradycardia and acidosis. The selection of the most efficient treatment strategy to achieve haemodynamic stability during spinal anaesthesia for caesarean section continues to be one of the main challenges in obstetric anaesthesiology. A number of measures for the prevention and treatment of spinal block-induced hypotension are used in clinical practice, such as preloading and coloading with crystalloid and/or colloid infusion, wrapping of lower limbs with compression stockings or bandages, administering an optimal dose of local anaesthetic and achieving an optimal spinal block level, left tilt positioning, and administering inotropes and vasopressors. Instead of administering vasopressors after a drop in blood pressure has already occurred, the latest algorithms recommend a prophylactic administration of vasopressor infusion. The preferred vasoconstrictor in this case is phenylephrine, which is associated with a lower incidence of foetal acidosis, and maternal nausea and vomiting compared to other vasoconstrictors.

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Influence of spinal hypotension on fetal oxidative status during elective cesarean section in uncomplicated pregnancies

Cited by 22 publications

References 12 publications

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes

Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy

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