A Randomized Double-blind Trial of Phenylephrine and Metaraminol Infusions for Prevention of Hypotension During Spinal and Combined Spinal-Epidural Anesthesia for Elective Cesarean Section

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(Anaesthesia. 2017;72(5):609–617)Currently phenylephrine, preferably as an infusion, is the drug of choice for the prevention and management of spinal anesthesia-induced hypotension during elective cesarean delivery. However, high doses of phenylephrine may result in maternal bradycardia, which can lead to decreased cardiac output and uteroplacental perfusion. While metaraminol is a vasopressor that has been used widely to maintain blood pressure and heart rate in nonobstetric patients, investigations in obstetrics, especially in comparison to phenylephrine have been limited. The current investigators decided to investigate metaraminol as an alternative to phenylephrine for the prevention of maternal hypotension during the administration of spinal or combined spinal-epidural anesthesia for elective cesarean sections (CS). They hypothesized that metaraminol would be at least noninferior to phenylephrine in terms of neonatal acid-base status.

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