Hypotension is an expected side effect of spinal anesthesia. In patients undergoing elective cesarean section, hypotension secondary to spinal anesthesia can have deleterious effects for both mother and neonate. Intravenous fluids and vasopressors are the first line treatment for spinal anesthesia-induced hypotension. While manual administration of these treatments is the current and standard practice, closed-loop automated systems (CLAS) may be a more effective method of managing intraoperative hypotension. The purpose of this systematic review was to compare the efficacy of closed-loop automated vasopressor administration with manual administration of vasopressors in maintaining a predetermined blood pressure target in obstetric patients receiving spinal anesthesia for elective cesarean section. A database search was conducted, and three studies were selected for inclusion in the systematic review according to PRISMA guidelines. The quality of the selected studies was assessed using the Critical Appraisal Skills Program questionnaire. Outcomes from each study were summarized and cross study analysis conducted. This systematic review found that utilization of a CLAS for vasopressor administration may improve some maternal outcomes as compared to vasopressors manually administered by an anesthesia provider. More research is needed to validate these findings as only three randomized controlled trials were included in this review. Regarding neonatal outcomes, this review found no clear advantage to using a CLAS over manually administered vasopressors. This review adds to the growing body of knowledge regarding the implementation of CLAS in anesthesia and will hopefully inspire further research in this burgeoning field.
