A Double-Blind, Placebo-Controlled Trial of Four Fixed Rate Infusion Regimens of Phenylephrine for Hemodynamic Support During Spinal Anesthesia for Cesarean Delivery

Allen, Terrence K.; George, Ronald B.; White, William D.; Muir, Holly A.; Habib, Ashraf S.

doi:10.1213/ane.0b013e3181e1db21

Cited by 143 publications

(127 citation statements)

References 23 publications

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“…[45][46][47][48] However, patients receiving phenylephrine by infusion also experience hypertensive events, the incidence of which appears to be proportional to the infusion rate. 49 Through its predominant a-adrenergic activity, phenylephrine causes an increase in peripheral vascular resistance that can lead to a reflex maternal bradycardia, and decreased cardiac output. 8,16 Ultimately, the total dose of phenylephrine by infusion usually exceeds 1,000 lg, significantly more than the total of bolus doses.…”

Section: Vasopressorsmentioning

confidence: 99%

“…8,16 Ultimately, the total dose of phenylephrine by infusion usually exceeds 1,000 lg, significantly more than the total of bolus doses. 46,49 In healthy parturients undergoing elective Cesarean delivery, the clinical importance of these drawbacks appears to be negligible as phenylephrine, even with high doses, does not cause fetal acidosis, nor neonatal cardiovascular or respiratory depression.…”

Section: Vasopressorsmentioning

confidence: 99%

“…[45][46][47][48] En revanche, les patientes recevant une perfusion de phényléphrine présentent aussi des épisodes d'hypertension, dont l'incidence semble proportionnelle au débit de la perfusion du vasopresseur. 49 La phényléphrine, par son activité a-adrénergique prédominante, entraîne une augmentation de la résistance vasculaire périphérique qui peut mener à une bradycardie maternelle réflexe ainsi qu'une baisse du débit cardiaque par rapport aux valeurs préperfusion. 8,16 Finalement, la dose totale de phényléphrine injectée en perfusion dépasse en général 1,000 lg et est significativement plus élevée que lorsque le vasopresseur est administré en bolus.…”

Section: Les Vasopresseursunclassified

“…8,16 Finalement, la dose totale de phényléphrine injectée en perfusion dépasse en général 1,000 lg et est significativement plus élevée que lorsque le vasopresseur est administré en bolus. 46,49 Chez les parturientes en santé subissant une césarienne programmée, l'importance clinique de l'ensemble de ces désavantages semble négligeable, puisque même à des doses élevées, la phényléphrine n'entraîne pas d'acidose foetale ni de dépression cardiovasculaire ou respiratoire néonatale.…”

Section: Les Vasopresseursunclassified

“…15,50 Deux études récentes suggèrent qu'un débit de phényléphrine entre 25 lgÁmin prévient efficacement l'hypotension tout en minimisant l'incidence d'hypertension et de bradycardie chez la mère. 16,49 Les épisodes de bradycardie accompagnée d'hypertension artérielle se traitent facilement par une réduction du débit de la perfusion de phényléphrine. Certaines patientes, cependant, présenteront une bradycardie accompagnée d'une hypotension; dans ce dernier cas, l'éphédrine demeure grandement indiquée et recommandée.…”

Section: Les Vasopresseursunclassified

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La prise en charge des liquides et des vasopresseurs pour la césarienne effectuée sous rachianesthésie

Loubert

2012

Can J Anesth/J Can Anesth

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Purpose The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. Principal findings Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 lgÁmin -1 ) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In preeclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.Conclusion A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Describe the main hemodynamic changes induced by spinal anesthesia in a pregnant woman undergoing a scheduled Cesarean delivery. 2. Recognize the clinical implications of those hemodynamic changes in the mother and fetus. 3. Explain the various strategies of vascular loading, and their main hemodynamic repercussions. 4. Assess the impact of using phenylephrine and ephedrine for the prevention and treatment of maternal hypotension. 5. Plan the fluid and vasopressor therapy in the case of an urgent Cesarean delivery.The increased popularity of regional anesthesia in clinical practice has led to a decrease in maternal mortality and morbidity related to complications in airway management. Spinal anesthesia is now the most popular technique for Cesarean delivery as it is easy to perform and provides a rapid onset, dense surgical block. It is not associated with a maternal or fetal risk of toxicity to local anesthetics. However, spinal anesthesia is often associated with significant maternal hypotension, with potentially significant consequences on maternal comfort, organ perfusion, and fetal well-being. Several studies suggest that the traditional approach that con...

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