Caesarean section [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Caesarean section ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1f9BUYPXGXDFlcKzodc61P_kqU5SDU-7weR_gZOcAYWUlZfM2f/?limit=15&utm_campaign=pubmed-2&fc=20241226053608}}
----
[[Vasopressor]]s are effective in managing perioperative [[hypotension]] in high-risk [[parturient]]s undergoing Caesarean [[section]] (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by [[neuraxial anesthesia]] remains a subject of [[investigation]].

Zhao et al. compared hypotension episodes among high-risk parturients who received [[ephedrine]], [[noradrenaline]], or [[phenylephrine]] by searching four [[electronic database]]s and reviewing the relevant references. [[Inclusion criteria]] encompassed [[randomized controlled trial]]s directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models.

They analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable.

The findings suggest the potential advantages of [[phenylephrine]] for reducing hypotensive episodes in high-risk parturients undergoing CS. [[Noradrenaline]] may emerge as an alternative, particularly for women at high risk of caesarean delivery
((Zhao S, Chen Q, Qin P, Liu L, Wei K. Comparison of vasopressors for management of hypotension in high-risk caesarean section under neuraxial anesthesia: a systematic review and network meta-analysis. BMC Anesthesiol. 2024 Dec 4;24(1):447. doi: 10.1186/s12871-024-02819-9. PMID: 39633265; PMCID: PMC11616188.))
----
Fetal [[aqueductal stenosis]] (AS) is one of the most common causes of [[congenital hydrocephalus]], which increases [[intracranial pressure]] due to partial or complete [[obstruction]] of [[cerebrospinal fluid flow]] within the [[ventricular system]]. Approximately 2-4 infants per 10,000 births develop AS, which leads to progressive [[hydrocephalus]], which enlarges the [[head]] often necessitating delivery by [[caesarean section]]