Ephedrine 1% nasal drops

Background and aimsSpinal-induced hypotension in parturients with pre-eclampsia (PE) can lead to adverse perinatal outcomes, making effective prophylaxis and treatment crucial. We aim to compare the prophylactic and therapeutic roles of phenylephrine, ephedrine, and norepinephrine (NE) in treating post-spinal hypotension in PE patients.MethodsWe conducted a comprehensive search of various databases up to June 2024, focusing on randomised clinical trials (RCTs). Standardised mean differences (SMDs) were used for continuous outcomes, while odds ratios (ORs) were employed for binary outcomes. Analyses were performed using R with both fixed-effect and random-effects models.ResultsNine RCTs (804 patients) were included in the analysis. Therapeutic comparisons revealed no differences in mean arterial pressure between NE and ephedrine (SMD = 0.51, 95% CI: -0.49, 1.53) or phenylephrine and ephedrine (SMD = 0.90, 95% CI: -0.01, 1.82). Phenylephrine was associated with a significantly higher risk of bradycardia compared to ephedrine (OR = 14.34, 95% CI: 1.8, 113.64, P = 0.018), whereas NE showed an insignificant difference (OR = 2.54, 95% CI: 0.27, 23.94). NE significantly improved the umbilical artery pH compared to ephedrine (SMD = 0.32, 95% CI: 0.02, 0.62, P = 0.036). No significant differences were identified in nausea or vomiting. Prophylactic comparisons revealed no significant differences between phenylephrine and NE for hypotension (OR = 0.98, 95% CI: 0.22, 4.26). For bradycardia, no difference was observed between NE and ephedrine (OR = 0.08, 95% CI: 0.002, 3.33) or phenylephrine and ephedrine (OR = 0.19, 95% CI: 0.006, 74).ConclusionsPhenylephrine, ephedrine, and NE exhibit comparable haemodynamic effects and maternal side effects, although phenylephrine increases the risk of bradycardia. NE improves umbilical artery pH.

Abstract licence: CC BY-NC-SA

BackgroundIntraoperative hypotension is a strong predictor of adverse outcomes in major abdominal surgery. However, data on the occurrence of intraoperative hypotension during the induction of general anesthesia are scarce. We hypothesized that early prevention of postinduction hypotension using a vasopressor could reduce postoperative adverse outcomes.MethodsIn this single-center randomized trial at Amiens Hospital University (Amiens, France), adults older than 50 yr with American Society of Anesthesiologists (Schaumburg, Illinois) Physical Status II or greater undergoing major abdominal surgery were assigned to ephedrine or norepinephrine groups. In the ephedrine group, titration with iterative boluses of ephedrine (3 mg · ml -1 ) was performed at the induction if intraoperative hypotension occurred. In the norepinephrine group, continuous intravenous injection of norepinephrine (0.016 mg · ml -1 ) was started at a rate of 0.48 mg · h -1 from the induction of anesthesia and was titrated if intraoperative hypotension occurred. The primary endpoint was any medico-surgical complication within 30 days (Clavien-Dindo score of 1 or greater). Secondary endpoints included hospital stay length, acute kidney injury, 1-month mortality, and cardiovascular, respiratory, neurologic, and infectious complications. Results were assessed by blinded evaluators.ResultsA total of 500 patients were randomized, and 473 were included in the intention-to-treat analysis. The cumulative episodes of intraoperative hypotension were significantly lower in the norephedrine group in comparison to the ephedrine group (respectively, 35 [15%] vs. 176 [74%]; P ConclusionsProphylactic titrated norepinephrine infusion to prevent postinduction hypotension was more effective than repeated ephedrine boluses and may reduce postoperative complications in major abdominal surgery.

Abstract licence: CC BY-NC-ND