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Anaesthesia · Obstetric anaesthesia: vasopressor for spinal at caesarean
Sample itemWhich vasopressor is generally preferred as a prophylactic infusion to prevent hypotension after spinal anaesthesia for caesarean section in a woman with a normal heart rate?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Phenylephrine
Phenylephrine maintains maternal blood pressure effectively and is associated with better umbilical artery pH than ephedrine, which crosses the placenta and increases fetal metabolism. It may cause reflex bradycardia, so it is used with caution when the heart rate is low. Ephedrine remains acceptable, particularly with bradycardia.
Option by option
A. Ephedrine
Ephedrine is associated with more fetal acidosis, although it remains an alternative.
B. Phenylephrine (correct)
Correct. It is the recommended first-line agent and gives less fetal acidosis than ephedrine.
C. Noradrenaline bolus
A noradrenaline bolus is not the standard approach, although infusions are sometimes used.
D. Dopamine
Dopamine is not a recommended agent for this use.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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