Prophylactic Infusions of Phenylephrine and Ephedrine during Combined Spinal Epidural Anaesthesia for Caesarean Section: A Comparative Study (original) (raw)
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Introduction: The present study was conducted to compare the effects of prophylactic phenylephrine and ephedrine infusion on maternal haemodynamics in elective caesarean section under spinal anaesthesia. It was hypothesized that prophylactic phenylephrine infusion would maintain better maternal haemodynamics than ephedrine infusion. Methods: Seventy six patients were available for randomization into two equal groups to receive either prophylactic infusion phenylephrine 100µg/ml/min (Group P, n=38) or infusion ephedrine 8mg/ml/min (Group E, n=38) after induction of spinal anaesthesia with 10mg hyperbaric bupivacaine with 15µg fentanyl. The infusion was adjusted according to the patient's systolic blood pressure and was administered up to the time of umbilical cord clamping. The incidence of adverse events, if any, was recorded. Apgar scores of every neonate were assessed at 1and 5 minute after delivery. Results: Both the drugs were able to prevent the incidence of hypotension. The systolic blood pressure and bradycardia was higher in phenylephrine group whereas the incidence of tachycardia was the common problem with ephedrine. Also, in phenylephrine group, the maximum upper level of sensory anaesthesia was two segments lower than ephedrine group and there was same neonatal outcome in both the groups. Conclusion: The prophylactic infusion of phenylephrine can be an effective alternative to ephedrine in the prevention of maternal hypotension without imparting any significant neonatal adverse effect. Lesser rostral spread of spinal anaesthetic drug was observed in mother receiving infusion of phenylephrine. However, bradycardia is a common problem with the use of phenylephrine.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Introduction: Hypotension is the most common serious adverse event associated with Spinal Anaesthesia (SA) and is associated with nausea and vomiting leading to pulmonary aspiration, respiratory depression and cardiac arrest. Phenylephrine (PE) and Ephedrine (EP) are vasopressors commonly used for prevention of hypotension associated with SA. Aim: To compare the efficacy and safety of PE and EP in prevention of hypotension induced by SA in women during Lower Segment Caesarean Section (LSCS) surgery. Materials and Methods: The present randomised clinical study was conducted on 60 women, between 18-36 years of age and a Heart Rate (HR) of 60-100 per minute randomised to receive either 100 mcg Intravenous (i.v.) bolus of PE, or 12 mg i.v. of EP during intrathecal block. Women having intraoperative hypotension were injected additional doses of vasopressor. Cardiovascular parameters were recorded at baseline (before block) and then at 1, 5, 10, 15, 30, 40 and 60 minutes. Further, safety ...
Indian Journal of Anaesthesia, 2011
Introduction: This randomized double blind study was started with an objective of management of spinal anaesthesia-induced hypotension in elective caesarean section by combining two commonly used vasopressors-ephedrine and phenylephrine in half of their usual doses with an expectation of reducing their foetomaternal side effects. Methods: One hundred and thirty two patients were randomized into three groups to receive either 100 µg/ml phenylephrine (group-P, n=31) or 3 mg/ml ephedrine (group-E, n=33) or 50 µg phenylephrine plus 1.5 mg ephedrine/ml (group-PE, n=29). Immediately after spinal injection the study solution was started prophylactically in every patient at the rate of 40 ml/h. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). Results: Mean fall of SBP was significantly more in group-E than group-P (P=0.009) and group-PE (P=0.013). This was not significantly different when compared between group-P and group-PE (P=0.9). Episodes of hypotension and tachycardia were more in group-E than the other two groups. Statistically significant tachycardia was seen in Group-E than that in other two groups. Incidence of bradycardia and hypertension did not differ significantly among the groups. Maternal nausea and Apgar score were also comparable in three groups. Conclusion: Current study claims that prophylactic phenylephrine 100 µg/ml is a better choice than ephedrine (3 mg/ml) or 50 mcg phenylephrine plus 1.5 mg ephedrine/ml in prevention of spinal anaesthesia-induced hypotension in elective caesarean section. Combination of two drugs in half the usual dose has no added advantage over phenylephrine, but this is better than ephedrine alone.
IOSR Journals , 2019
Maternal hemodynamic changes are common after spinal anaesthesia during caesarean section. Our study aims to compare efficacy of ephedrine and phenylephrine in treatment of hypotension secondary to spinal anaesthesia for caesarean section and their effects on foetal outcome. This observational cross-sectional study was conducted in parturient attending Obs. & Gynae OPD from August 20.A total of 50 patients 18 to Nov 2018.A total of 60 patients were included in study. Assessment was done in terms of BP & HR (recorded every 2 mins for 20 mins and every 5 min till the end of surgery.), neonatal Apgar score( at 1 & 5 mins of delivery). All data were tabulated as mean ± SD. P value <0.001 was considered statistically significant Ephedrine & Phenylephrine are efficient in treating spinal anaesthesia induced maternal hypotension during caesarean section without any adverse effects on neonates.
Journal of Medical Science And clinical Research, 2018
The commonest form of anaesthesia for caesarean section is spinal anaesthesia. It is associated with a fall in blood pressure with a comparable fall in uteroplacental blood flow. This leads to fetal hypoxia and acidosis. Baseline and intra operative heart rate and blood pressure were compared in sixty patients. The hemodynamic variables were noted in patients given oral ephedrine 30mg thirty minutes before subarachnoid block and patients given intravenous fluid preload alone. Statistically significant variation in heart rate and blood pressure were noted in the two groups. Lowest incidence of hypotension and change in heart rate was observed in the ephedrine group. The incidence of hypotension was less in the ephedrine group. No adverse effect of ephedrine was noted in the mother or fetus. Oral ephedrine is a simple and effective prophylactic measure to prevent hypotension due to spinal anaesthesia.
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 ...