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Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials.
Int J Obstet Anesth 2019; 39:42-50IJ

Abstract

INTRODUCTION

During caesarean section, the use of a vasopressor is often required to achieve haemodynamic stability of the parturient. Metaraminol is a vasopressor used in this context in some countries. However, the differences between metaraminol and other vasopressors remain unclear.

METHODS

A search of the PubMed, Cochrane Library, and Embase databases was performed to identify randomised controlled trials comparing the use of metaraminol with other vasopressors during spinal anaesthesia at caesarean section. The selected studies were subjected to meta-analysis and risk-of-bias assessment.

RESULTS

Four randomised, controlled trials met the selection criteria and 409 parturients who underwent an elective caesarean section were included in this meta-analysis. The quality of these trials was good. Metaraminol was associated with higher umbilical arterial pH (standardised mean difference [SMD] 0.82, 95% CI 0.01 to 1.62, P=0.05); a lower incidence of fetal acidosis (RR 0.08, 95% CI 0.01 to 0.63, P=0.02); and a lower incidence of nausea or vomiting (RR 0.16, 95% CI 0.04 to 0.57, P=0.0005) than was ephedrine. Metaraminol resulted in higher umbilical arterial pH (SMD 0.42, 95% CI 0.15 to 0.68, P=0.002) but a higher incidence of reactive hypertension (RR 1.80, 95% CI 1.32 to 2.46, P=0.0002) than did phenylephrine.

CONCLUSION

The results of this study showed that for spinal anaesthesia at elective caesarean section, metaraminol may be a more suitable vasopressor than ephedrine and its effects are at least not inferior to those of phenylephrine.

Authors+Show Affiliations

Department of Anaesthesia, Sijhih Cathay General Hospital, New Taipei City, Taiwan.Department of Anaesthesia, Sijhih Cathay General Hospital, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.Department of Anaesthesia, Sijhih Cathay General Hospital, New Taipei City, Taiwan.Department of Anaesthesia, Sijhih Cathay General Hospital, New Taipei City, Taiwan.Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. Electronic address: 10462@s.tmu.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30772119

Citation

Chao, E, et al. "Metaraminol Use During Spinal Anaesthesia for Caesarean Section: a Meta-analysis of Randomised Controlled Trials." International Journal of Obstetric Anesthesia, vol. 39, 2019, pp. 42-50.
Chao E, Sun HL, Huang SW, et al. Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials. Int J Obstet Anesth. 2019;39:42-50.
Chao, E., Sun, H. L., Huang, S. W., Liao, J. H., Ma, P. L., & Chen, H. C. (2019). Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials. International Journal of Obstetric Anesthesia, 39, pp. 42-50. doi:10.1016/j.ijoa.2019.01.009.
Chao E, et al. Metaraminol Use During Spinal Anaesthesia for Caesarean Section: a Meta-analysis of Randomised Controlled Trials. Int J Obstet Anesth. 2019;39:42-50. PubMed PMID: 30772119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metaraminol use during spinal anaesthesia for caesarean section: a meta-analysis of randomised controlled trials. AU - Chao,E, AU - Sun,H-L, AU - Huang,S-W, AU - Liao,J-H, AU - Ma,P-L, AU - Chen,H-C, Y1 - 2019/01/25/ PY - 2018/05/28/received PY - 2019/01/12/revised PY - 2019/01/18/accepted PY - 2019/2/18/pubmed PY - 2019/2/18/medline PY - 2019/2/18/entrez KW - Caesarean section KW - Ephedrine KW - Meta-analysis KW - Metaraminol KW - Phenylephrine KW - Spinal anaesthesia KW - Systematic review SP - 42 EP - 50 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 39 N2 - INTRODUCTION: During caesarean section, the use of a vasopressor is often required to achieve haemodynamic stability of the parturient. Metaraminol is a vasopressor used in this context in some countries. However, the differences between metaraminol and other vasopressors remain unclear. METHODS: A search of the PubMed, Cochrane Library, and Embase databases was performed to identify randomised controlled trials comparing the use of metaraminol with other vasopressors during spinal anaesthesia at caesarean section. The selected studies were subjected to meta-analysis and risk-of-bias assessment. RESULTS: Four randomised, controlled trials met the selection criteria and 409 parturients who underwent an elective caesarean section were included in this meta-analysis. The quality of these trials was good. Metaraminol was associated with higher umbilical arterial pH (standardised mean difference [SMD] 0.82, 95% CI 0.01 to 1.62, P=0.05); a lower incidence of fetal acidosis (RR 0.08, 95% CI 0.01 to 0.63, P=0.02); and a lower incidence of nausea or vomiting (RR 0.16, 95% CI 0.04 to 0.57, P=0.0005) than was ephedrine. Metaraminol resulted in higher umbilical arterial pH (SMD 0.42, 95% CI 0.15 to 0.68, P=0.002) but a higher incidence of reactive hypertension (RR 1.80, 95% CI 1.32 to 2.46, P=0.0002) than did phenylephrine. CONCLUSION: The results of this study showed that for spinal anaesthesia at elective caesarean section, metaraminol may be a more suitable vasopressor than ephedrine and its effects are at least not inferior to those of phenylephrine. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/30772119/Metaraminol_use_during_spinal_anaesthesia_for_caesarean_section:_a_meta_analysis_of_randomised_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(18)30250-4 DB - PRIME DP - Unbound Medicine ER -