Preoperative Oral Midodrine versus Intraoperative Intravenous Norepinephrine in Preventing Post- Spinal Anesthesia Hypotension: Review Article | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 51, Volume 100, Issue 1, July 2025, Page 2887-2893 PDF (402.62 K) | ||||
| DOI: 10.21608/ejhm.2025.440603 | ||||
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| Abstract | ||||
| Background: Spinal anesthesia (SA)–induced hypotension is a frequent and potentially serious complication during Cesarean delivery, affecting up to 80–90% of parturients and contributing to maternal symptoms (Nausea & dizziness) and adverse fetal outcomes (Acidosis & bradycardia). While, preload and co-loading strategies offer limited benefit, vasopressor prophylaxis remains the cornerstone of management. Oral midodrine—a prodrug α₁-adrenergic agonist—and intravenous norepinephrine—a potent α-agonist with mild β₁ activity—have emerged as promising agents to stabilize systemic vascular resistance and maintain arterial pressure. Objective: This article aimed to critically review and compare the efficacy, safety, and practical considerations of preoperative oral midodrine versus intraoperative continuous norepinephrine infusion for the prevention of SA–mediated hypotension in CSs. Methods: We searched PubMed, Google Scholar, and Science Direct for Midodrine, Norepinephrine, Spinal anaesthesia, Hypotension, Cesarean section, Vasopressor prophylaxis. Only the thorough investigation, from 1994 to 2019, was taken into account. The writers evaluated relevant literature references as well. Documents written in languages other than English have been ignored. Papers that were not regarded as significant scientific research included dissertations, oral presentations, conference abstracts, and unpublished manuscripts were excluded. Conclusions: Both preoperative midodrine (5–10 mg orally ≥60 minutes before block) and low-dose norepinephrine infusions (2–8 µg/min) significantly reduce the incidence and severity of post-spinal hypotension. Midodrine’s ease of administration and sustained effect suit settings without infusion pumps, while norepinephrine allows rapid, dynamic titration for tighter blood pressure (BP) control. Future large-scale trials are warranted to standardize dosing, validate fetal safety, and integrate these strategies into enhanced recovery protocols. | ||||
| Keywords | ||||
| Midodrine; Norepinephrine; Spinal anaesthesia; Hypotension; Cesarean section; Vasopressor prophylaxis | ||||
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