You are administering spinal anesthesia during an urgent cesarean delivery for a nonreassuring fetal heart rate. According to a recent study, which of the following outcomes is MOST likely in this parturient if you administer norepinephrine for maternal hypotension, compared to a similar parturient receiving phenylephrine?
Guidelines from ASA and the Society for Obstetric Anesthesia and Perinatology recommend ephedrine or phenylephrine for treating maternal hypotension following spinal anesthesia for cesarean delivery. However, the guidelines also cite evidence that phenylephrine may more effectively treat hypotension and improve umbilical artery pH compared to ephedrine. Thus, phenylephrine – via preemptive infusion or rescue bolus – has gained favor in this setting.
More recently, norepinephrine, with both α- and β-adrenergic agonist properties, has been explored as a potential replacement for phenylephrine. However, outcomes in relatively uncomplicated cesarean deliveries have been equivocal, and essentially no studies have compared these agents in the setting of potential...
