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The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension during Elective Cesarean Delivery under Spinal Anesthesia.
Biomed Res Int. 2018; 2018:1869189.BR

Abstract

Maternal hypotension commonly occurs during spinal anesthesia for cesarean delivery, with a decrease of systemic vascular resistance recognized as a significant contributor. Accordingly, counteracting this effect with a vasopressor that constricts arterial vessels is appropriate, and the pure α-adrenergic receptor agonist phenylephrine is the current gold standard for treatment. However, phenylephrine is associated with dose-dependent reflex bradycardia and decreased cardiac output, which can endanger the mother and fetus in certain circumstances. In recent years, the older, traditional vasopressor norepinephrine has attracted increasing attention owing to its mild β-adrenergic effects in addition to its α-adrenergic effects. We search available literature for papers directly related to norepinephrine application in spinal anesthesia for elective cesarean delivery. Nine reports were found for norepinephrine use either alone or compared to phenylephrine. Results show that norepinephrine efficacy in rescuing maternal hypotension is similar to that of phenylephrine without obvious maternal or neonatal adverse outcomes, and with a lower incidence of bradycardia and greater cardiac output. In addition, either computer-controlled closed loop feedback infusion or manually-controlled variable-rate infusion of norepinephrine provides more precise blood pressure management than equipotent phenylephrine infusion or norepinephrine bolus. Thus, based on the limited available literature, norepinephrine appears to be a promising alternative to phenylephrine; however, before routine application begins, more favorable high-quality studies are warranted.

Authors+Show Affiliations

Department of Anesthesiology, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, China.Department of Anesthesiology, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, China.Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.Nanjing Medical University, Nanjing, China.Department of Anesthesiology, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, China.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30687737

Citation

Wang, Xian, et al. "The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension During Elective Cesarean Delivery Under Spinal Anesthesia." BioMed Research International, vol. 2018, 2018, p. 1869189.
Wang X, Shen X, Liu S, et al. The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension during Elective Cesarean Delivery under Spinal Anesthesia. Biomed Res Int. 2018;2018:1869189.
Wang, X., Shen, X., Liu, S., Yang, J., & Xu, S. (2018). The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension during Elective Cesarean Delivery under Spinal Anesthesia. BioMed Research International, 2018, 1869189. https://doi.org/10.1155/2018/1869189
Wang X, et al. The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension During Elective Cesarean Delivery Under Spinal Anesthesia. Biomed Res Int. 2018;2018:1869189. PubMed PMID: 30687737.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Efficacy and Safety of Norepinephrine and Its Feasibility as a Replacement for Phenylephrine to Manage Maternal Hypotension during Elective Cesarean Delivery under Spinal Anesthesia. AU - Wang,Xian, AU - Shen,Xiaofeng, AU - Liu,Shijiang, AU - Yang,Jianjun, AU - Xu,Shiqin, Y1 - 2018/12/31/ PY - 2018/09/19/received PY - 2018/11/17/revised PY - 2018/12/04/accepted PY - 2019/1/29/entrez PY - 2019/1/29/pubmed PY - 2019/5/10/medline SP - 1869189 EP - 1869189 JF - BioMed research international JO - Biomed Res Int VL - 2018 N2 - Maternal hypotension commonly occurs during spinal anesthesia for cesarean delivery, with a decrease of systemic vascular resistance recognized as a significant contributor. Accordingly, counteracting this effect with a vasopressor that constricts arterial vessels is appropriate, and the pure α-adrenergic receptor agonist phenylephrine is the current gold standard for treatment. However, phenylephrine is associated with dose-dependent reflex bradycardia and decreased cardiac output, which can endanger the mother and fetus in certain circumstances. In recent years, the older, traditional vasopressor norepinephrine has attracted increasing attention owing to its mild β-adrenergic effects in addition to its α-adrenergic effects. We search available literature for papers directly related to norepinephrine application in spinal anesthesia for elective cesarean delivery. Nine reports were found for norepinephrine use either alone or compared to phenylephrine. Results show that norepinephrine efficacy in rescuing maternal hypotension is similar to that of phenylephrine without obvious maternal or neonatal adverse outcomes, and with a lower incidence of bradycardia and greater cardiac output. In addition, either computer-controlled closed loop feedback infusion or manually-controlled variable-rate infusion of norepinephrine provides more precise blood pressure management than equipotent phenylephrine infusion or norepinephrine bolus. Thus, based on the limited available literature, norepinephrine appears to be a promising alternative to phenylephrine; however, before routine application begins, more favorable high-quality studies are warranted. SN - 2314-6141 UR - https://www.unboundmedicine.com/medline/citation/30687737/The_Efficacy_and_Safety_of_Norepinephrine_and_Its_Feasibility_as_a_Replacement_for_Phenylephrine_to_Manage_Maternal_Hypotension_during_Elective_Cesarean_Delivery_under_Spinal_Anesthesia_ L2 - https://doi.org/10.1155/2018/1869189 DB - PRIME DP - Unbound Medicine ER -