Do fetuses need vasopressors just before their birth?

Excerpt

Spinal anesthesia-induced hypotension (SAIH), caused by the use of spinal anesthesia for cesarean delivery, poses a major threat to both mother and child, and its prevention and cure are still the subject of intensive research [1]. Recent studies have focused on ondansetron administration immediately before spinal anesthesia as a simple method of preventing SAIH [2, 3]. Norepinephrine is also attracting attention as the third-choice vasopressor after ephedrine and phenylephrine [4, 5]. Karacaer et al. conducted a study using ondansetron to prevent SAIH and to reduce norepinephrine required to treat it, and published the results in the February edition of this journal [6]. They found that, although there was no significant difference in the incidence of SAIH, the primary outcome, between patients who received 8 mg ondansetron intravenously 5 min before the induction of spinal anesthesia and those who received a placebo, the dose of norepinephrine required to treat hypotension, one of the secondary outcomes, was significantly lower in the ondansetron group. The fact that prophylactic ondansetron administration enables a further reduction in the dose of norepinephrine, which is considered to have a lower risk of neonatal acidemia than ephedrine and phenylephrine, is a valuable finding for the management of spinal anesthesia for cesarean section. However, I also took another important message from this paper, in addition to the one the authors intended to convey. …