Tags

Type your tag names separated by a space and hit enter

Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review.
Can J Anaesth. 2002 Jun-Jul; 49(6):588-99.CJ

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

Authors+Show Affiliations

Department of Anaesthesia, Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Nt, Hong Kong, China. annalee@cuhk.edu.hkNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

12067872

Citation

Lee, Anna, et al. "Prophylactic Ephedrine Prevents Hypotension During Spinal Anesthesia for Cesarean Delivery but Does Not Improve Neonatal Outcome: a Quantitative Systematic Review." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 49, no. 6, 2002, pp. 588-99.
Lee A, Ngan Kee WD, Gin T. Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review. Can J Anaesth. 2002;49(6):588-99.
Lee, A., Ngan Kee, W. D., & Gin, T. (2002). Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 49(6), 588-99.
Lee A, Ngan Kee WD, Gin T. Prophylactic Ephedrine Prevents Hypotension During Spinal Anesthesia for Cesarean Delivery but Does Not Improve Neonatal Outcome: a Quantitative Systematic Review. Can J Anaesth. 2002 Jun-Jul;49(6):588-99. PubMed PMID: 12067872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review. AU - Lee,Anna, AU - Ngan Kee,Warwick D, AU - Gin,Tony, PY - 2002/6/18/pubmed PY - 2002/9/11/medline PY - 2002/6/18/entrez SP - 588 EP - 99 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 49 IS - 6 N2 - 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 [CI], 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% CI, 0.55 to 3.35) or the incidence of low Apgar scores (< 7 or < 8) at one minute (RR, 0.77; 95% CI, 0.29 to 2.06) and five minutes (RR, 0.72; 95% CI, 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. SN - 0832-610X UR - https://www.unboundmedicine.com/medline/citation/12067872/Prophylactic_ephedrine_prevents_hypotension_during_spinal_anesthesia_for_Cesarean_delivery_but_does_not_improve_neonatal_outcome:_a_quantitative_systematic_review_ L2 - https://dx.doi.org/10.1007/bf03017387 DB - PRIME DP - Unbound Medicine ER -