Control of Spinal Anesthesia-Induced Hypotension in Adults

Figures & data

Table 1 Drug Strategies for the Control of Spinal Anaesthesia-Induced Hypotension (SAIH) in Adults

Medications	Modes of Action	Population	Comments	Main References
Atropine	Antimuscarinic effect, HR increase	Elderly	Small dose (5 µg/kg) prevent SAIH Attention to high-risk cardiac patients	Lim et al^Citation35
Ephedrine	Sympathomimetic amine acting directly on α- and β-adrenergic receptors and indirectly by increasing the release of endogenous catecholamine (norepinephrine)	Caesarean section ++ Adults	The dose of ephedrine during elective caesarean section should not exceed 15 mg (stimulation of foetal metabolism) Role to play in patients with SAIH and bradycardia	Kinsella and Tuckey^Citation4 Lee et al 2004^Citation71 Dyer et al 2009^Citation72
Phenylephrine	Direct-acting α(1)-adrenergic receptor agonist	Caesarean section ++ Elderly	Strong evidence ++ The effect of phenylephrine on cardiac output is dependent on the starting conditions of the return function Prophylactic phenylephrine infusion (immediately following intrathecal injection) reduces SAIH	Ngan Kee et al^Citation45 Ngan Kee 2010^Citation73 Ferré et al 2016^Citation11
Norepinephrine	Potent α-adrenergic and weak β-adrenergic receptor agonist activity	Caesarean section	Further studies are necessary before considering whether norepinephrine is preferable to phenylephrine for the prevention of SAIH	Ngan Kee et al^Citation49 Carvalho et al^Citation52
Cafedrine/Theodrenaline	β-Sympathomimetic effects	Caesarean section	Only few safety data from controlled trials available More data is needed	Koch et al^Citation67 Marcus et al^Citation68
Ondansetron	Serotonin receptor antagonists: inhibition of the BJR by a blockade of 5- hydroxytryptamine Type 3 receptors	Caesarean section ++ Elderly	A decrease in the incidence of SAIH has never clearly been demonstrated More data is needed	Terkawi et al^Citation64 Owczuk et al^Citation61

Abbreviations: SAIH, spinal anaesthesia-induced hypotension; HR, heart rate; BJR, Bezold–Jarisch reflex.

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