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–1 AGONISTS VS EPHEDRINE FOR C/S HYPOTENSION: A SYSTEMATIC REVIEW

From the Department of Anaesthesia, Sunnybrook and Women's Health Sciences Centre, 76 Grenville St. Toronto, Ontario M5S 1B2

INTRODUCTION

Because -1 agonists have been shown to have deleterious effects on uterine blood flow in animals, ephedrine has become the vasopressor of choice in the hypotensive obstetric patient. We report a systematic review of human studies to determine if -1 agonists cause harm to the neonate.

METHODS

We searched Medline, Embase, and the Cochrane Database from 1966 to present. Key words used were phenylephrine, ephedrine, pregnancy and cesarean section. We also hand searched appropriate journals and supplements for the last 5yrs. We excluded non-human studies. We included any study comparing ephedrine to an -1 agonist to treat or prevent hypotension due to neuroaxial blockade for elective cesarean section in full term parturients. All RCT=s were rated using a validated 5 point scoring system, with a score of 3 being high quality. Two independent investigators completed searching and scoring. The primary outcome was UApH. The secondary outcome were neonatal Apgar scores. Because of heterogeneous methodology, we did not combine the results mathematically, rather we used a graphical display.

RESULTS

We found 13 studies comprised of 737 patients that met our inclusion criteria. 12/13 RCTs–9 were of high quality. -1 agonists used included phenylephrine in 10 studies, angiotensin II in 2, and metaraminol in 1. 7 studies used prophylactic vasopressor, 5 used only rescue doses, and 1 study included either. 5 studies showed no significant difference in UApH between groups (one compared UV pH, with no significant difference). 8 studies showed significantly better UA pHs in the -1 agonist group (Figure). There were no significant differences in Apgar scores.

View larger version (12K): [in this window] [in a new window]   L'Abbe Plot of Cord pH––Ephedrine VS Alpha-1 Agonists

Animal studies have shown ephedrine to be better for the fetus than -1 agonists. This systematic review of human studies has shown -1 agonists to be equally as safe or better than ephedrine. The use of -1 agonists in obstetric patients deserves further investigation.

REFERENCES

Available from MC.

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