Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;98(1):e13947.
doi: 10.1097/MD.0000000000013947.

Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia: A Systematic review and network meta-analysis protocol

Choongun Ryu  1 , Geun Joo Choi, Yong Hee Park, Hyun Kang
Affiliations

Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia: A Systematic review and network meta-analysis protocol

Choongun Ryu et al. Medicine (Baltimore). 2019 Jan.

Abstract

Background: Spinal anesthesia is the standard technique for elective cesarean section, but the incidence of maternal hypotension in this setting is reportedly about 80%, without any prophylactic management. Vasopressors are the most reliable method for counteracting the hypotension induced by spinal anesthesia. However, studies investigating the effects of vasopressors have yielded inconsistent and debatable results. Therefore, we plan to conduct a systematic review and network meta-analysis to identify the most effective vasopressor to prevent maternal hypotension, and to decrease fetal acidosis in women undergoing spinal anesthesia for elective cesarean section.

Methods: A systematic and comprehensive search to detect all the randomized controlled studies on vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia will be performed using information in the databases, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar, beginning from their inception to October 2018. We will conduct a network meta-analysis to combine the direct and indirect comparisons of the vasopressors. We will use the surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of vasopressors. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool. All statistical analyses will be performed using Stata SE version 15.0.

Ethics and dissemination: This systematic review and meta-analysis will be published in a peer-reviewed journal. Ethical approval and informed consent are not required, as the study will be a literature review and will not involve direct contact with patients or alterations to patient care.

Trial registration number: The protocol for this review has been registered in the PROSPERO network (registration number: CRD42018111852).

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. Riley ET, Cohen SE, Macario A, et al. Spinal versus epidural anesthesia for cesarean section: a comparison of time efficiency, costs, charges, and complications. Anesth Analg 1995;80:709–12. - PubMed
    1. Fettes PD, Jansson JR, Wildsmith JA. Failed spinal anaesthesia: mechanisms, management, and prevention. Br J Anesth 2009;102:739–48. - PubMed
    1. Dyer RA, Biccard BM. Ephedrine for spinal hypotension during elective caesarean section: the final nail in the coffin? Acta Anaesthesiol Scand 2012;56:807–9. - PubMed
    1. Clark RB, Thompson DS, Thompson CH. Prevention of spinal hypotension associated with Cesarean section. Anesthesiology 1976;45:670–4. - PubMed
    1. Hall PA, Bennett A, Wilkes MP, et al. Spinal anaesthesia for caesarean section: comparison of infusions of phenylephrine and ephedrine. Br J Anaesth 1994;73:471–4. - PubMed

MeSH terms

Substances