Which vasopressor for caesarean section?

One of the longest running debates in obstetric anaesthesia surrounds the prevention and treatment of maternal hypotension during caesarean section. Anaesthetic techniques have evolved and maternal mortality and morbidity is markedly reduced, but hypotension remains a problem, particularly following neuraxial blockade. Despite over 30 years of research no definitive consensus has been reached on the best treatment strategy and particular controversy surrounds the use of vasopressive agents. This article explores the evidence relating to the three most commonly used agents in the UK: ephedrine, phenylepherine and metaraminol.