Review Note
Last Update: 03/02/2025 08:19 PM
Current Deck: ACG Part 2::Obstetrics
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Commit #293194
SS_OB 1.27 Evaluate methods to treat hypotension associated with neuraxial blockade for caesarean birth
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Commit #293194Dense block to T4 leads causes sympathetic block and associated vasodilation -> leading to hypotension.
Goal BP : within 10-20% of baseline BP unless patient has severe HTN
- (always <160 SBP, and <110 DBP)
- Avoid hypotension as placental perfusion pressure dependent
VASOPRESSORS
- Phenylephrine : direct alpha agonists. 25-50mcg/min
- Associated maternal bradycardia (more than noradrenaline)
- Noradrenaline low dose : 7mcg/ml, 7-14mcg bolus, 20-30mls/hr infusion
- Less maternal bradycardia, and no significant increase in adverse affects for fetus.
- Increased risk of extravascular necrosis compared to phenylephrine
- Metaraminol
- Less studied than others, indirect and direct alpha agonist
- Ephedrine - direct and indireact alpha + beta
- Associated with lower neonate pH