A b s t r a c tIntroduction: 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.

Aim: Direct laryngoscopy and endotracheal intubation following induction of anesthesia almost always triggers powerful cardiovascular responses. The purpose of this study was to investigate the efficacy of diltiazem (calcium channel blocker), lidocaine (sodium channel blocker) and a combination of these two drugs in the attenuation of circular responses to endotracheal intubation in normotensive patients.Methods: 120 Patients were randomly assigned to one of the following four groups. Group I received a single 0.2 mg/kg IV bolus of diltiazem 1 minute prior to laryngoscopy and intubation (n=30), Group II received a single 1.5 mg/kg IV bolus of lidocaine (n=30) 3 minutes prior and Group III received combination of these two drugs 1 minute prior to laryngoscopy and intubation (n=30). Group IV served as the control and received a single 5 mL IV bolus of normal saline. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured and then compared within and between groups. Rate pressure product (RPP) was calculated and evaluated as well.Results:Either diltiazem or lidocaine alone blunts unwanted hemodynamic responses to intubation. However, significantly less circulatory responses were experienced by patients receiving both than those receiving either lidocaine or diltiazem alone.Conclusion: Given the difference in the pharmacological mechanisms of these two drugs, the prophylactic therapy with combination of diltiazem+lidocaine is significantly more effective than any one alone for attenuating hemodynamic changes to laryngoscopy and tracheal intubation, without producing increased risk of hypertension.