Vasoactive drugs for the management of maternal arterial hypotension after spinal anesthesia for cesarean section. An updated integrative narrative review

Abstract

Spinal neuraxial anesthesia remains the technique of choice due to its large number of maternal-fetal advantages over general anesthesia. However, its adverse effects, such as hypotension, nausea and vomiting continue to represent an important source of morbimortality and a challenge for anesthesiologists. Currently, there are different strategies for its prevention and management, vasoactive drugs being one of the mainstay treatments. In recent years different pharmacological alternatives and administration schemes have emerged in hopes of finding the ideal one and ending this dilemma. The objective of this integrative narrative review is to provide an update on vasoactive drugs used in cesarean section with the latest available evidence. To date, norepinephrine seems to achieve hemodynamic stability with a lower rate of maternal-fetal complications in patients without other associated complications.