Kundra 2008.

Study characteristics
Methods	RCT
Participants	60 women Inclusion criteria: ASA class I and II, single term pregnancies, scheduled for elective caesarean under spinal anaesthesia Exclusion criteria: pre‐existing or pregnancy‐induced hypertension, known cardiovascular disease or contraindications to spinal anaesthesia Setting: India
Interventions	Ephedrine versus crystalloid preload Group 1: ephedrine: ephedrine infusion prepared in 0.9% NS (1 mg/mL), started prophylactically at a rate of 5 mg/min for the first 2 min and then at a rate of 1 mg/min for the next 18 min, following administration of spinal anaesthetic Group 2: crystalloid preload: Ringer's lactate 500 mL, infused rapidly over 15‐20 min before institution of spinal anaesthetic All women received a standardised spinal anaesthetic technique and dose followed by a standardised crystalloid infusion. Hypotension requiring intervention received 5 mg IV bolus ephedrine, repeated if necessary.
Outcomes	Maternal: hypotension; induction to birth time; total ephedrine dose; adverse effects; heart rate Neonatal: Apgar scores; umbilical venous gases
Notes	Hypotension was defined as a > 20% fall in SBP
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Randomly divided into two groups"
Allocation concealment (selection bias)	Unclear risk	Sealed envelope
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Described as "single‐blinded" but unlikely that blinding was possible as women in the ephedrine group had 2 separate IV lines established, while those in the crystalloid group had only 1 line
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Not reported
Incomplete outcome data (attrition bias) All outcomes	Low risk	None reported
Selective reporting (reporting bias)	Unclear risk	Neonatal outcomes not reported in a form that could be used in this review
Other bias	Low risk	Similar baseline characteristics