Int J Med Sci 2021; 18(4):1039-1050. doi:10.7150/ijms.54002

Research Paper

Pharmacological strategies to prevent haemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A network meta-analysis

Sang Won Yoon1#, Geun Joo Choi1#, Hee-Kyeong Seong1, Myeong Jong Lee2, Hyun Kang1✉

1. Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
2. Department of Anaesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Republic of Korea
#Sang Won Yoon and Geun Joo Choi equally contributed to this study

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Citation:
Yoon SW, Choi GJ, Seong HK, Lee MJ, Kang H. Pharmacological strategies to prevent haemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A network meta-analysis. Int J Med Sci 2021; 18(4):1039-1050. doi:10.7150/ijms.54002. Available from https://www.medsci.org/v18p1039.htm

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Abstract

Objective: This network meta-analysis (NMA) aimed to determine the relative efficacy and safety of pharmacological strategies used to mitigate haemodynamic instability by intubation for general anaesthesia in hypertensive parturient women undergoing caesarean section.

Methods: We considered randomised controlled studies comparing the effects of pharmacological strategies used to alleviate haemodynamic instability during intubation in parturient women with hypertensive disorders of pregnancy. The primary endpoints were maximum blood pressure and heart rate after intubation, and secondary endpoints were the Apgar scores at 1 and 5 min. NMA allowed us to combine direct and indirect comparisons between strategies.

Results: Twelve studies evaluating nine pharmacological strategies in 619 patients were included. According to the surface under the cumulative ranking curve, the maximal mean arterial pressure was lowest for high-dose remifentanil (99.4%) followed by nitroglycerin (73.6%) and labetalol (60.9%). The maximal heart rate was lowest for labetalol (99.9%) followed by high dose of remifentanil (81.2%) and fentanyl (61.6%). Apgar score at 1 min was higher with low-dose than with high-dose remifentanil (mean difference, 0.726; 95% confidence interval, 0.056 to 1.396; I2=0.0%).

Conclusions: High-dose remifentanil produces minimum blood pressure changes, while labetalol is most effective in maintaining normal heart rate in parturient women with hypertensive disorders of pregnancy during caesarean section under general anaesthesia.

Keywords: Caesarean section, pregnancy-induced hypertension, intubation, pregnancy