Prevention of post-spinal hypotension in high risk cesarean delivery: A systematic review and updated network meta-analysis of prophylactic vasopressor infusions.

Our subgroup and sensitivity analyses confirmed the effectiveness of phenylephrine in preventing hypotension but suggested caution in patients with baseline low cardiac reserve.[ 33 ] Norepinephrine, characterised by mixed α-adrenergic and low β-adrenergic activity, demonstrated a comparable hypotension prevention profile and was associated in several studies[ 15 , 32 ] with better cardiac output maintenance and a lower incidence of bradycardia than phenylephrine; however, pooled subgroup analyses did not reach statistical significance.[ 20 ] This aligns with current evidence placing norepinephrine as an acceptable, if not superior, alternative to phenylephrine for patients experiencing hemodynamic instability or requiring active maintenance of cardiac output.[ 34 ] The reduced risk of maternal bradycardia in this review validates its growing role in obstetric anaesthesia.[ 35 ] In contrast, ephedrine, once an obstetric vasopressor standard of care, had the least suitable profile.

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