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Vasopressor use for spinal hypotension during Cesarean delivery: A Bayesian network meta-analysis of fetal and maternal outcomes
Abstract Number: T2B-92
Abstract Type: Original Research
Introduction: Spinal anesthesia is the preferred anesthetic for cesarean delivery however the resultant hypotension from the sympathectomy can be dangerous to the fetus and mother. There have been multiple paradigm shifts as to what the ideal vasopressor is in treating this syndrome. These have included ephedrine, phenylephrine, mephentermine, metaraminol, and most recently studies have begun examining the role of norepinephrine. This network meta-analysis (NMA) is the first that compares and ranks vasopressors for spinal hypotension. This comes at an opportune time as norepinephrine has developing interest and research efforts.
Methods: Multiple databases were searched for randomized controlled trials comparing vasopressors in treatment of spinal hypotension for cesarean delivery. Pooled estimates for fetal acid-base status and maternal outcomes were calculated using a Bayesian modeling. The risk of bias in the included trials was assessed based upon the Cochrane Collaboration recommendations.
Results: 51 randomized controlled trials with a total of 3955 patients matched our inclusion criterion. NMA was evaluated using a random-effect model. Our initial evaluation examined umbilical ABG pH and base excess. Metaraminol had the lowest probability of having acidosis on umbilical ABG, followed by mephentermine, phenylephrine, norepinephrine and ephedrine. Norepinephrine has lowest probability of having a large base excess followed closely by mephentermine and metaraminol, and then phenylephrine and ephedrine.
Conclusions: While the data involving norepinephrine is limited, this NMA demonstrates it may not be superior to medications such as metaraminol. At the time of the conference we will have run regression models to separate the outcomes based on continuous versus intermittent, prophylactic versus therapeutic, elective versus emergent cesarean delivery, and to evaluate maternal outcomes. This serves as the first ever network meta-analysis to compare vasopressor outcomes after spinal hypotension during cesarean delivery.