We have located links that may give you full text access.
Journal Article
Review
Vasopressors in obstetrics: what should we be using?
Current Opinion in Anaesthesiology 2006 June
PURPOSE OF REVIEW: Historically, ephedrine has been recommended as the best vasopressor in obstetrics because animal studies showed it caused less reduction in uterine blood flow compared with alpha-agonists. Recent clinical evidence, however, suggests that this is not as important as initially thought. This review evaluates current data with a focus on spinal anesthesia for cesarean section.
RECENT FINDINGS: Ephedrine and phenylephrine have been most investigated. Advantages of ephedrine include familiarity, long history and low propensity for uteroplacental vasoconstriction. Ephedrine, however, has limited efficacy, is difficult to titrate, causes maternal tachycardia and depresses fetal pH and base excess. Advantages of phenylephrine include high efficacy, ease of titration and the ability to use liberal doses to maintain maternal blood pressure near normal and then prevent nausea and vomiting without causing fetal acidosis. Phenylephrine, however, may decrease maternal heart rate and cardiac output and few data are available on its use in high-risk cases. Combination of a phenylephrine infusion and rapid crystalloid cohydration is the first method described that reliably prevents hypotension.
SUMMARY: When current evidence is considered, in the authors' opinion, phenylephrine is the vasopressor that most closely meets the criteria for the best vasopressor in obstetrics.
RECENT FINDINGS: Ephedrine and phenylephrine have been most investigated. Advantages of ephedrine include familiarity, long history and low propensity for uteroplacental vasoconstriction. Ephedrine, however, has limited efficacy, is difficult to titrate, causes maternal tachycardia and depresses fetal pH and base excess. Advantages of phenylephrine include high efficacy, ease of titration and the ability to use liberal doses to maintain maternal blood pressure near normal and then prevent nausea and vomiting without causing fetal acidosis. Phenylephrine, however, may decrease maternal heart rate and cardiac output and few data are available on its use in high-risk cases. Combination of a phenylephrine infusion and rapid crystalloid cohydration is the first method described that reliably prevents hypotension.
SUMMARY: When current evidence is considered, in the authors' opinion, phenylephrine is the vasopressor that most closely meets the criteria for the best vasopressor in obstetrics.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app