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Anesthesia and Analgesia, 2002
This quantitative systematic review compared the efficacy and safety of ephedrine with phenylephrine for the prevention and treatment of hypotension during spinal anesthesia for cesarean delivery. Seven randomized controlled trials (n ϭ 292) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were maternal hypotension, hypertension and bradycardia, and neonatal umbilical cord blood pH values and Apgar scores. For the management (prevention and treatment) of maternal hypotension, there was no difference between phenylephrine and ephedrine (relative risk [RR] of 1.00; 95% confidence interval [CI], 0.96 -1.06). Maternal bradycardia was more likely to occur with phenylephrine than with ephedrine (RR of 4.79; 95% CI, 1.47-15.60). Women given phenylephrine had neonates with higher umbilical arterial pH values than those given ephedrine (weighted mean difference of 0.03; 95% CI, 0.02-0.04). There was no difference between the two vasopressors in the incidence of true fetal acidosis (umbilical arterial pH value of Ͻ7.2; RR of 0.78; 95% CI, 0.16 -3.92) or Apgar score of Ͻ7 at 1 and 5 min. This systematic review does not support the traditional idea that ephedrine is the preferred choice for the management of maternal hypotension during spinal anesthesia for elective cesarean delivery in healthy, nonlaboring women.
Iranian journal of medical sciences, 2015
Spinal anesthesia is an accepted technique in elective cesarean sections. However, hypotension, resulted from sympathectomy is a common problem, especially in pregnant women. Prevention of this complication by sympathomimetic agents is of potential clinical significance. The aim of this study is to compare the effect of prophylactic infusion of Phenylephrine versus Ephedrine in the prevention of hypotension during spinal anesthesia in elective cesarean section. Eighty-three patients were enrolled in this study and randomly divided into three groups. Group Ph received phenylephrine infusion, group E received ephedrine infusion while group P were delivered placebo. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded. There was an insignificant difference in demographic data between the groups. Systolic and diastolic blood pressures were higher ...
Journal of Biomedical Sciences, 2017
Introduction: The incidence of hypotension after administration of anesthesia in the spinal canal in women undergoing abdominal surgical delivery may be about to eighty percent if preventive amplifications, for instance precedent the introduction of additional fluid into the body, propelling the uterus to the left, and vasopressors, have not been considered. Aims: are to analyze the effect of ephedrine and phenylephrine in prophylaxis and treatment of low blood pressure in patients undergoing spinal anesthesia, to figure out the side effects of these drugs and to determine fetal Apgar scores. Method: Fifty five women were randomly designated into two groups to get preventative ephedrine (n=27) or phenylephrine (n=28). Blood pressure, heart rate, frequency of low blood pressure, reactive high blood pressure, heart rate less than 60 BPM, heart rate more than 100 BPM, nausea, vomiting, and Apgar scores were checked out. Results: There were no significant differences in the characteristic data between the groups. The mean (± SD) dose of ephedrine used was 19.81 mg (± 5.46) and phenylephrine was 125.71 µg (± 35.64). Differences in systolic and diastolic pressure were compatible in the two groups. There were significant alterations in the frequency of reactive hypertension episodes (Ephedrine group: 48 (14.5%) vs. Phenylephrine group: 26 (7.7%) P<0.005). There were no divergence in the frequency of bradycardia (Ephedrine group: 3 (11.1%) vs. Phenylephrine group: 6 (21.4%) P>0.301). There were significant differences in the incidence of nausea and vomiting (Ephedrine group: 10 (37%) vs. Phenylephrine group: 3(10.7%); P>0.018). There were no significant diversity in the incidence of hypotension, with an incidence of 18(66.7%) in the Ephedrine group and 17(60.7%) (P<0.646) in the Phenylephrine group. Maternal arrhythmias were more common in the Ephedrine group at 10(37%) than in the Phenylephrine group at 7(25%), but the difference is not significant (P=0.334). Additionally, maternal restlessness was more common in the Ephedrine group: 8(30.8%) than the Phenylephrine group: 3(10.7%), but with an insignificant difference (P=0.068). Diversity in the Apgar score in the 1st and 5th minute was not observed. Number of patients who required rescue dose in the Ephedrine group was 24(88.9%), which was significantly higher than the Phenylephrine group at 20(71.4%), P<0.005). There are significant differences in the number of rescue doses of the two drugs. In the Phenylephrine group there was only one patient (3.6%) that had the rescue dose 3 times, and for the Ephedrine group there were 9 patients (33.3%) that had the rescue dose 3 times each, (P=0.033).
Anesthesiology, 2001
Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baselin...
Pakistan Journal of Medical and Health Sciences, 2022
Maternal haemodynamic variations are communal during caesarean section by spinal anesthesia. Several measures are adopted to treat hypotension. The aim of this study is to compare the effectiveness of phenylephrine and ephedrine in treating and preventing hypotension during C-section by spinal anesthesia and its outcome on the condition of the fetus. Place and Duration: In the Anesthesia department of Divisional Headquarter teaching Hospital Mirpur Azad Kashmir for six-months duration from July 2021 to December 2021. Methods: 120 total ASA grade-I patients with normal single pregnancy over 36 weeks who endured planned caesarean-section under spinal-anesthesia were randomized into 2 groups equally. Group I was given 5 mg rescue bolus and 10 mg prophylactic bolus dose of ephedrine intravenously during intrathecal block. Group II received 50 µg of rescue bolus and 100 µg of an intravenous dose of prophylactic phenylephrine bolus during intrathecal block. Haemodynamic variables such as ...
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Hemodynamic instability during pregnancy may compromise the blood flow to the uteroplacental bed which may lead fetal acidosis. We compared ephedrine and phenylephrine on fetal outcome and hypotension during elective cesarean section. Aim: To compare the effectiveness of ephedrine versus phenylephrine in fetal outcome and the treatment of fall in blood pressure during subarachnoid block for elective cesarean section. Materials and Methods: Study Design: Prospective, randomized, double blind. Based on inclusion and exclusion criteria 50 patients were selected and divided into two equal groups. All patients were done under subarachnoid block as per routine in our hospital. Group E received Ephedrine 6mg if >20% fall in the heart rate and systolic blood pressure from the baseline. Group P received phenylephrine 20mcg as increments if>20% fall in the heart rate and systolic blood pressure from the baseline. Results: Both the groups were comparable with regard to the fetal outcome (Apgar score and fetal umbilical vein ABG). Nylephrine group showed statistically significant fall in heart rate and systolic blood pressure when compared to the Ephedrine group during the first 20minutes. After 25th minute both the drugs were comparable. Conclusion: Both the drugs were comparable with respect to the fetal outcome and maternal hemodynamics in patients undergoing elective cesarean section under subarachnoid block. Keywords: Ephedrine, Phenylephrine, Hypotension, Subarachnoid block, Cesarean section.
Archives of Medical Science, 2010
Introduction: Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia. Material and methods: The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n = 50). Group P received 1 ml phenylephrine (100 µg/ml) with normal saline if hypotension developed (n = 50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups. Results: All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group. Conclusions: Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.
International Journal of Obstetric Anesthesia, 2018
Background: Phenylephrine is the preferred vasopressor for the prevention and treatment of spinal anaesthesia-induced hypotension during caesarean section, because studies on low-risk elective patients found it to have a less detrimental effect on umbilical artery pH compared with ephedrine. However, limited data exist from high-risk parturients and parturients with uteroplacental insufficiency. Methods: We systematically searched for randomised, controlled, double-blinded trials of these two vasopressors in high-risk caesarean sections. We applied conventional meta-analysis, trial sequential analysis, computing the required information size that would exclude type I and II errors, contour-enhanced funnel plot testing for publication bias, meta-regression to assess the dose-response relationship, and the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE). The incidence of fetal acidosis (umbilical arterial pH <7.2) was the primary outcome. Results: Eight trials (712 patients) with low risk of bias were identified. Pooling six studies of patients with preeclampsia and other reasons for fetal compromise, as well as subgroup analysis of the preeclampsia studies, revealed no significant differences in the incidence of fetal acidosis. Trial sequential analysis showed that the required information size was not reached. The funnel plot was not suggestive of publication bias. Meta-regression showed no dose-response relationship. The GRADE score was moderate quality. Conclusions: Despite several studies and a large number of patients there was insufficient evidence to make a recommendation for choice of vasopressor in high-risk caesarean section. Trials with adequate power to detect differences in the incidence of fetal acidosis between ephedrine and phenylephrine are required to provide evidence-based guidance.