Do fetuses need vasopressors just before their birth?

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Date: Aug. 2018
From: Journal of Anesthesia(Vol. 32, Issue 4)
Publisher: Springer
Document Type: Editorial
Length: 1,276 words
Lexile Measure: 1560L

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Author(s): Hiroyuki Sumikura 1

Author Affiliations:

(Aff1) 0000 0004 1762 2738, grid.258269.2, Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Juntendo University, , 3-1-3 Hongo, Bunkyo-ku, Tokyo, Japan

Spinal anesthesia-induced hypotension (SAIH), caused by the use of spinal anesthesia for cesarean delivery, poses a major threat to both mother and child, and its prevention and cure are still the subject of intensive research [1]. Recent studies have focused on ondansetron administration immediately before spinal anesthesia as a simple method of preventing SAIH [2, 3]. Norepinephrine is also attracting attention as the third-choice vasopressor after ephedrine and phenylephrine [4, 5]. Karacaer et al. conducted a study using ondansetron to prevent SAIH and to reduce norepinephrine required to treat it, and published the results in the February edition of this journal [6]. They found that, although there was no significant difference in the incidence of SAIH, the primary outcome, between patients who received 8 mg ondansetron intravenously 5 min before the induction of spinal anesthesia and those who received a placebo, the dose of norepinephrine required to treat hypotension, one of the secondary outcomes, was significantly lower in the ondansetron group. The fact that prophylactic ondansetron administration enables a further reduction in the dose of norepinephrine, which is considered to have a lower risk of neonatal acidemia than ephedrine and phenylephrine, is a valuable finding for the management of spinal anesthesia for cesarean section. However, I also took another important message from this paper, in addition to the one the authors intended to convey.

The vital message I have gleaned from this paper is the importance of shortening the interval between the induction of spinal anesthesia and delivery of the fetus. In this prospective study of elective cesarean deliveries, the interval between the induction of anesthesia and the start of surgery was approximately 7 min and that from the start of surgery to delivery was approximately 6 min, making a...

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Gale Document Number: GALE|A548010815