Lee Sandra, Islam Nehal, Ladha Karim S, Bicket Mark C, Wijeysundera Duminda N
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Can J Anaesth. 2025 May;72(5):721-737. doi: 10.1007/s12630-025-02925-3. Epub 2025 Apr 17.
Hypotension occurs frequently during neuraxial anesthesia and is associated with increased risks of perioperative complications. We sought to conduct a systematic review and meta-analysis of randomized controlled trials that evaluated interventions intended to mitigate exposure to intraoperative hypotension and prevent complications following the administration of neuraxial anesthesia for major nonobstetric noncardiac surgery.
We searched MEDLINE, Embase, PubMed®, and the Cochrane Controlled Register of Trials (database inception to 2 August 2023) for randomized controlled trials (RCTs) that evaluated interventions intended to reduce hypotension during neuraxial anesthesia in major noncardiac nonobstetric surgery, without any restrictions on the comparator type. The outcomes of interest were any measure of intraoperative hypotension (e.g., incidence, duration) and postoperative complications.
Among 33 included RCTs (n = 3,880) evaluating six classes of interventions, interventions that reduced the risk of hypotension included colloid preload (vs crystalloid, risk ratio [RR], 0.48; 95% confidence interval [CI], 0.30 to 0.80; P = 0.004; I = 12%; very-low-certainty evidence) and prophylactic ondansetron (vs placebo; RR, 0.64; 95% CI, 0.53 to 0.78; P < 0.001; I = 39%; moderate-certainty evidence). Prophylactic ephedrine was also associated with reduced time spent in hypotension. Nevertheless, crystalloid preloading did not reduce risks of hypotensive events compared with no preload (RR, 1.36; 95% CI, 0.96 to 1.92; P = 0.09; I = 0%; very-low-certainty evidence). There were no compelling data showing that these interventions reduced the risks of complications.
Several interventions hold promise for mitigating exposure to hypotension following neuraxial anesthesia, albeit supported by very-low to moderate-certainty evidence. It remains unclear whether these interventions reduce the risks of postoperative complications.
PROSPERO ( CRD42022336197 ); first submitted 29 May 2022.
低血压在神经轴索麻醉期间频繁发生，并与围手术期并发症风险增加相关。我们试图对随机对照试验进行系统评价和荟萃分析，这些试验评估了旨在减轻术中低血压暴露并预防非产科非心脏大手术神经轴索麻醉后并发症的干预措施。
我们检索了MEDLINE、Embase、PubMed®和Cochrane对照试验注册库（数据库起始至2023年8月2日），以查找评估旨在减少非产科非心脏大手术神经轴索麻醉期间低血压的干预措施的随机对照试验（RCT），对对照类型没有任何限制。感兴趣的结局是术中低血压的任何测量指标（如发生率、持续时间）和术后并发症。
在纳入的33项RCT（n = 3880）中，评估了六类干预措施，降低低血压风险的干预措施包括胶体预负荷（与晶体液相比，风险比[RR]，0.48；95%置信区间[CI]，0.30至0.80；P = 0.004；I² = 12%；极低确定性证据）和预防性昂丹司琼（与安慰剂相比；RR，0.64；95%CI，0.53至0.78；P < 0.001；I² = 39%；中度确定性证据）。预防性麻黄碱也与低血压持续时间缩短相关。然而，与无预负荷相比，晶体液预负荷并未降低低血压事件的风险（RR，1.36；95%CI，0.96至1.92；P = 0.09；I² = 0%；极低确定性证据）。没有令人信服的数据表明这些干预措施降低了并发症风险。
尽管有很低到中度确定性证据支持，但有几种干预措施有望减轻神经轴索麻醉后低血压的暴露。这些干预措施是否能降低术后并发症风险仍不清楚。
PROSPERO（CRD42022336197）；首次提交于2022年5月29日。
