{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:38:21Z","timestamp":1788691101941,"version":"build-2803163510"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Phenylephrine is recommended for the management of hypotension after spinal anaesthesia in women undergoing caesarean section. Noradrenaline, an adrenergic agonist with weak \u03b2\u2010adrenergic activity, has been reported to have a more favourable haemodynamic profile than phenylephrine. However, there are concerns that noradrenaline may be associated with a higher risk of fetal acidosis, defined as an umbilical artery\n                    <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\n                    &lt;\u00a07.20. We performed a systematic review of trials comparing noradrenaline with phenylephrine, concentrating on primary outcomes of fetal acidosis and maternal hypotension. We identified 13 randomised controlled trials including 2002 patients. Heterogeneity among the studies was high, and there were too few data to calculate a pooled effect estimate. Fetal acidosis was assessed in four studies that had a low risk of bias and a low risk of confounding, that is, studies which used a prophylactic vasopressor and where women received the allocated vasopressor only. There were no significant differences between these studies. No significant differences were observed for hypotension. Two trials found a significantly lower incidence of bradycardia when using noradrenaline. Cardiac output was significantly higher after noradrenaline in two of three studies. For other secondary outcomes including nausea, vomiting and Apgar scores at 1 and 5\u00a0min, no studies found significant differences. The evidence so far is too limited to support an advantage of noradrenaline over phenylephrine. Concerns of a deleterious effect of noradrenaline on fetal blood gas status cannot currently be assuaged by the available data from randomised controlled studies.\n                  <\/jats:p>","DOI":"10.1111\/anae.14976","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T16:11:06Z","timestamp":1580746266000},"page":"800-808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["A systematic review of phenylephrine vs. noradrenaline for the management of hypotension associated with neuraxial anaesthesia in women undergoing caesarean section"],"prefix":"10.1111","volume":"75","author":[{"given":"M.","family":"Heesen","sequence":"first","affiliation":[{"name":"Department of Anaesthesia Kantonsspital Baden Baden Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Hilber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Kantonsspital Baden Baden Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Rijs","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Erasmus University Medical Centre Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Rossaint","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospital RWTH Aachen Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Girard","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospital Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.J.","family":"Mercier","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia A. B\u00e9cl\u00e8re Hospital \u2013 APHP &amp; Paris\u2010Saclay University Clamart France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Klimek","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Erasmus University Medical Centre Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1111\/j.1399-6576.2010.02239.x","article-title":"Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients","volume":"54","author":"Kl\u00f6hr S","year":"2010","journal-title":"Acta Anaesthesiologica Scandinavica"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1097\/ALN.0b013e31818a401f","article-title":"Continuous invasive blood pressure and cardiac output monitoring during Caesarean delivery: a randomized, double\u2010blind comparison of low\u2010dose versus high\u2010dose spinal anesthesia with intravenous phenylephrine or placebo infusion","volume":"109","author":"Langesaeter E","year":"2008","journal-title":"Anesthesiology"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/j.1399-6576.2011.02646.x","article-title":"Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta\u2010analysis","volume":"56","author":"Veeser M","year":"2012","journal-title":"Acta Anaesthesiologica Scandinavica"},{"key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/ALN.0b013e3181b160a3","article-title":"Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery","volume":"111","author":"Ngan Kee WD","year":"2009","journal-title":"Anesthesiology"},{"key":"e_1_2_6_6_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1111\/anae.14080","article-title":"International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia","volume":"73","author":"Kinsella SM","year":"2018","journal-title":"Anaesthesia"},{"key":"e_1_2_6_7_1","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/anae.13007","article-title":"Vasopressors for the treatment of maternal hypotension following spinal anaesthesia for elective caesarean section: past, present and future","volume":"70","author":"Heesen M","year":"2015","journal-title":"Anaesthesia"},{"key":"e_1_2_6_8_1","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/ALN.0000000000000601","article-title":"Randomized double\u2010blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery","volume":"122","author":"Ngan Kee WD","year":"2015","journal-title":"Anesthesiology"},{"key":"e_1_2_6_9_1","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1213\/ANE.0000000000002755","article-title":"Bolus norepinephrine administration and fetal acidosis at cesarean delivery under spinal anesthesia","volume":"126","author":"Cooper DW","year":"2018","journal-title":"Anesthesia and Analgesia"},{"key":"e_1_2_6_10_1","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1213\/ANE.0000000000001846","article-title":"Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: a sequential allocation dose\u2010finding study","volume":"125","author":"Onwochei DN","year":"2017","journal-title":"Anesthesia and Analgesia"},{"key":"e_1_2_6_11_1","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/ALN.0000000000002483","article-title":"Norepinephrine infusion for preventing postspinal anesthesia hypotension during cesarean delivery: a randomized dose\u2010finding trial","volume":"130","author":"Hasanin AM","year":"2019","journal-title":"Anesthesiology"},{"key":"e_1_2_6_12_1","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta\u2010analyses: the PRISMA statement","volume":"151","author":"Moher D","year":"2009","journal-title":"Annals of Internal Medicine"},{"key":"e_1_2_6_13_1","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1111\/j.1365-2044.1982.tb01278.x","article-title":"Spinal anaesthesia for caesarean section. 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