<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1870-7203</journal-id>
<journal-title><![CDATA[Acta médica Grupo Ángeles]]></journal-title>
<abbrev-journal-title><![CDATA[Acta méd. Grupo Ángeles]]></abbrev-journal-title>
<issn>1870-7203</issn>
<publisher>
<publisher-name><![CDATA[Grupo Ángeles, Servicios de Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1870-72032023000200134</article-id>
<article-id pub-id-type="doi">10.35366/110259</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Efedrina versus norepinefrina para inestabilidad hemodinámica materna secundaria a bloqueo subaracnoideo en cesárea]]></article-title>
<article-title xml:lang="en"><![CDATA[Ephedrine versus norepinephrine for maternal hypotension in cesarean section under spinal anesthesia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Albisua Aguilar]]></surname>
<given-names><![CDATA[José Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ortega Vallado]]></surname>
<given-names><![CDATA[Francisco]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carrillo Torres]]></surname>
<given-names><![CDATA[Orlando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lazo Gómez]]></surname>
<given-names><![CDATA[Rafael]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinto Segura]]></surname>
<given-names><![CDATA[María Elena]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Angeles Clínica Londres Servicio de Anestesiología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital General de México &#8220;Dr. Eduardo Liceaga&#8221; Servicio de Anestesiología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad Panamericana Escuela de Psicología ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<volume>21</volume>
<numero>2</numero>
<fpage>134</fpage>
<lpage>139</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S1870-72032023000200134&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S1870-72032023000200134&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S1870-72032023000200134&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  el bloqueo subaracnoideo es la modalidad de anestesia que más se utiliza en cesárea electiva, pero conlleva el riesgo de inestabilidad hemodinámica materna (hipotensión y bradicardia). El uso de vasopresores como efedrina en bolo o norepinefrina en infusión permite controlar la presión arterial, pero no existe suficiente evidencia para guiar la elección del agente específico.  Objetivos:  comparar la frecuencia de eventos de inestabilidad hemodinámica en mujeres sometidas a cesárea electiva con bloqueo subaracnoideo tratadas con efedrina o con norepinefrina.  Material y métodos:  realizamos un ensayo clínico fase IV, pragmático, de etiqueta abierta y de no inferioridad. Los desenlaces primarios fueron el número de eventos de bradicardia e hipotensión, y también se registraron eventos de náusea, vómito, eventos adversos graves y puntaje de Apgar.  Resultados:  el uso de norepinefrina redujo el riesgo de hipotensión en 71%, de náusea en 93% y de emesis en 67%. No se observaron diferencias en los eventos de bradicardia ni en el puntaje de la escala de Apgar.  Conclusión:  la norepinefrina no es inferior a la efedrina para el manejo terapéutico de la hipotensión materna asociada a bloqueo subaracnoideo en cesárea electiva.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  subarachnoid spinal block is the form of anesthesia more commonly used for elective cesarean section, though it carries the risk of maternal hemodynamic instability (hypotension or bradycardia). Vasopressors, such as ephedrine in bolus or infused norepinephrine, prevent this adverse event, though the evidence to guide vasopressor choice is insufficient.  Objectives:  to compare the frequency of hemodynamic instability events in women undergoing elective cesarean section with subarachnoid spinal block treated with ephedrine or norepinephrine.  Material and methods:  we performed a pragmatic, open-label, non-inferiority, phase IV clinical trial, in which the primary outcomes were the number of bradycardia and hypotension events. We also studied the number of nausea and vomiting events, severe adverse events, and Apgar scores.  Results:  infused norepinephrine reduced 71% the risk of hypotension, 93% the risk of nausea, and 67% the risk of vomiting. There were no differences in the number of bradycardia events or Apgar scores.  Conclusion:  norepinephrine is non-inferior to ephedrine to treat maternal hypotension due to subarachnoid spinal block in elective cesarean section.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[bloqueo subaracnoideo]]></kwd>
<kwd lng="es"><![CDATA[cesárea]]></kwd>
<kwd lng="es"><![CDATA[efedrina]]></kwd>
<kwd lng="es"><![CDATA[escala de Apgar]]></kwd>
<kwd lng="es"><![CDATA[hipotensión]]></kwd>
<kwd lng="es"><![CDATA[norepinefrina]]></kwd>
<kwd lng="en"><![CDATA[spinal anesthesia]]></kwd>
<kwd lng="en"><![CDATA[cesarean section]]></kwd>
<kwd lng="en"><![CDATA[ephedrine]]></kwd>
<kwd lng="en"><![CDATA[Apgar score]]></kwd>
<kwd lng="en"><![CDATA[hypotension]]></kwd>
<kwd lng="en"><![CDATA[norepinephrine]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ibarra-López]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Santalla-Piñeiro]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Carabeo-Pujol]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[López-Espinosa]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Legón-Carrillo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Profilaxis de la hipotensión arterial en la cesárea de urgencia]]></article-title>
<source><![CDATA[MediCiego]]></source>
<year>2017</year>
<volume>23</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>12-8</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Montoya-Botero]]></surname>
<given-names><![CDATA[BH]]></given-names>
</name>
<name>
<surname><![CDATA[Oliveros-Wilches]]></surname>
<given-names><![CDATA[CI]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno-Martínez]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Manejo de la hipotensión inducida por anestesia espinal para cesárea]]></article-title>
<source><![CDATA[Rev Colomb Anestesiol]]></source>
<year>2009</year>
<volume>37</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>131-40</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Mao]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Qian]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Shen]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Shen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A randomized double-blind study comparing prophylactic norepinephrine and ephedrine infusion for preventing maternal spinal hypotension during elective cesarean section under spinal anesthesia: A CONSORT-compliant article]]></article-title>
<source><![CDATA[Medicine (Baltimore)]]></source>
<year>2019</year>
<volume>98</volume>
<numero>51</numero>
<issue>51</issue>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Qi]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Qiu]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Yan]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efficacy and safety of different norepinephrine regimens for prevention of spinal hypotension in cesarean section: a randomized trial]]></article-title>
<source><![CDATA[Biomed Res Int]]></source>
<year>2018</year>
<volume>2018</volume>
<page-range>2708175</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aragao]]></surname>
<given-names><![CDATA[FF]]></given-names>
</name>
<name>
<surname><![CDATA[Aragao]]></surname>
<given-names><![CDATA[PW]]></given-names>
</name>
<name>
<surname><![CDATA[Martins]]></surname>
<given-names><![CDATA[CA]]></given-names>
</name>
<name>
<surname><![CDATA[Salgado Filho]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Barroqueiro]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia]]></article-title>
<source><![CDATA[Rev Bras Anestesiol]]></source>
<year>2014</year>
<volume>64</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>299-306</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bolaños-Arboleda]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Fonseca-Ruiz]]></surname>
<given-names><![CDATA[NJ]]></given-names>
</name>
<name>
<surname><![CDATA[Socha-García]]></surname>
<given-names><![CDATA[NI]]></given-names>
</name>
<name>
<surname><![CDATA[García-Peñuela]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Monsalve-Mejía]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Etilefrina vs. fenilefrina en hipotensión por anestesia espinal para cesárea: ensayo clínico multicéntrico, controlado, aleatorizado y doble ciego]]></article-title>
<source><![CDATA[Rev Colomb Anestesiol]]></source>
<year>2016</year>
<volume>44</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>89-96</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hasanin]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Amin]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Agiza]]></surname>
<given-names><![CDATA[NA]]></given-names>
</name>
<name>
<surname><![CDATA[Elsayed]]></surname>
<given-names><![CDATA[MK]]></given-names>
</name>
<name>
<surname><![CDATA[Refaat]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Hussein]]></surname>
<given-names><![CDATA[HA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Norepinephrine infusion for preventing postspinal anesthesia hypotension during cesarean delivery: a randomized dose-finding trial]]></article-title>
<source><![CDATA[Anesthesiology]]></source>
<year>2019</year>
<volume>130</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>55-62</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saravanan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Kocarev]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Wilson]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Watkins]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Columb]]></surname>
<given-names><![CDATA[MO]]></given-names>
</name>
<name>
<surname><![CDATA[Lyons]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section]]></article-title>
<source><![CDATA[Br J Anaesth]]></source>
<year>2006</year>
<volume>96</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>95-9</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Miranda]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lacassie]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fluidoterapia para la prevención de hipotensión arterial secundaria a anestesia espinal en operación cesárea: ¿tenemos todas las respuestas?]]></article-title>
<source><![CDATA[Rev Chil Anest]]></source>
<year>2017</year>
<volume>46</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>80-5</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Simon]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Provenchere]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[de Saint Blanquat]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Boulay]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Hamza]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dose of prophylactic intravenous ephedrine during spinal anesthesia for cesarean section]]></article-title>
<source><![CDATA[J Clin Anesth]]></source>
<year>2001</year>
<volume>13</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>366-9</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Onwochei]]></surname>
<given-names><![CDATA[DN]]></given-names>
</name>
<name>
<surname><![CDATA[Ngan Kee]]></surname>
<given-names><![CDATA[WD]]></given-names>
</name>
<name>
<surname><![CDATA[Fung]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Downey]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Ye]]></surname>
<given-names><![CDATA[XY]]></given-names>
</name>
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[JCA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Norepinephrine intermittent intravenous boluses to prevent hypotension during spinal anesthesia for cesarean delivery: a sequential allocation dose-finding study]]></article-title>
<source><![CDATA[Anesth Analg]]></source>
<year>2017</year>
<volume>125</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>212-8</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[X]]></given-names>
</name>
<name>
<surname><![CDATA[Mao]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Yang]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparative study of bolus norepinephrine, phenylephrine, and ephedrine for the treatment of maternal hypotension in parturients with preeclampsia during cesarean delivery under spinal anesthesia]]></article-title>
<source><![CDATA[Med Sci Monit]]></source>
<year>2019</year>
<volume>25</volume>
<page-range>1093-101</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Veeser]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Hofmann]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Roth]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Klohr]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Rossaint]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Heesen]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis]]></article-title>
<source><![CDATA[Acta Anaesthesiol Scand]]></source>
<year>2012</year>
<volume>56</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>810-6</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vallejo]]></surname>
<given-names><![CDATA[MC]]></given-names>
</name>
<name>
<surname><![CDATA[Attaallah]]></surname>
<given-names><![CDATA[AF]]></given-names>
</name>
<name>
<surname><![CDATA[Elzamzamy]]></surname>
<given-names><![CDATA[OM]]></given-names>
</name>
<name>
<surname><![CDATA[Cifarelli]]></surname>
<given-names><![CDATA[DT]]></given-names>
</name>
<name>
<surname><![CDATA[Phelps]]></surname>
<given-names><![CDATA[AL]]></given-names>
</name>
<name>
<surname><![CDATA[Hobbs]]></surname>
<given-names><![CDATA[GR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery]]></article-title>
<source><![CDATA[Int J Obstet Anesth]]></source>
<year>2017</year>
<volume>29</volume>
<page-range>18-25</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<source><![CDATA[Norma Oficial Mexicana NOM-006-SSA3-2011, Para la práctica de la anestesiología]]></source>
<year>2012</year>
<publisher-loc><![CDATA[México ]]></publisher-loc>
<publisher-name><![CDATA[Diario Oficial de la Federación]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Macarthur]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Riley]]></surname>
<given-names><![CDATA[ET]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery]]></article-title>
<source><![CDATA[Int Anesthesiol Clin]]></source>
<year>2007</year>
<volume>45</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>115-32</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
