A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise

Dyer, Robert A.; Emmanuel, Andy; Adams, Sabirah; Lombard, Carl; Arcache, M.J.; Vorster, A.; Wong, Cynthia A.; Higgins, Nicole; Reed, Anthony; James, Michael F.; Joolay, Yaseen; Schulein, S.; Dyk, Dominique van

doi:10.1016/j.ijoa.2017.08.001

Cited by 39 publications

(22 citation statements)

References 15 publications

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“…This study was not powered to detect betweengroup differences in umbilical cord gases; a further adequately powered study has been completed in this regard, using non-invasive maternal blood pressure monitoring. This showed that fetal acid base status is independent of whether phenylephrine or ephedrine is used to treat spinal hypotension in severe pre-eclampsia with fetal compromise [16]. In conclusion, we found that cardiac output increased in response to spinal anaesthesia in women with severe early onset pre-eclampsia, and that a small dose of phenylephrine reversed the haemodynamic changes more effectively than ephedrine.…”

Section: Discussionsupporting

confidence: 51%

Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre‐eclampsia: a randomised, controlled trial

et al. 2017

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SummaryWe examined the haemodynamic effects of colloid preload, and phenylephrine and ephedrine administered for spinal hypotension, during caesarean section in 42 women with severe early onset pre-eclampsia. Twenty patients with predelivery spinal hypotension were randomly allocated to receive an initial dose of either 50 lg phenylephrine or 7.5 mg ephedrine; the primary outcome was percentage change in cardiac index. After a 300-ml colloid preload, mean (SD) cardiac index increased from 4.9 (1.1) to 5.6 (1.2) l.min À1 .m À2 (p < 0.01), resulting from an increase in both heart rate, from 81.3 (17.2) to 86.3 (16.5) beats.min À1 (p = 0.2), and stroke volume, from 111.8 (19.0) to 119.8 (17.9) ml (p = 0.049).Fourteen (33%) and 23 (54.8%) patients exhibited a stroke volume response > 10% and > 5%, respectively; a significant negative correlation was found between heart rate and stroke volume changes. Spinal hypotension in 20 patients was associated with an increase from baseline in cardiac index of 0.6 l.min À1 .m À2 (mean difference 11.5%; p < 0.0001). After a median [range] dose of 50 lg phenylephrine or 15 [7.5-37.5] mg ephedrine, the percentage change in cardiac index during the measurement period of 150 s was greater, and negative, in patients receiving phenylephrine vs. ephedrine, at À12.0 (7.3)% vs. 2.6 (6.0)%, respectively (p = 0.0001). The percentage change in heart rate after vasopressor was higher in patients receiving phenylephrine, at À9.1 (3.4)% vs. 5.3 (12.6)% (p = 0.0027), as was the change in systemic vascular resistance, at 22.3 (7.5) vs. À1.9 (10.5)% (p < 0.0001). Phenylephrine effectively reverses spinal anaesthesiainduced haemodynamic changes in severe pre-eclampsia, if left ventricular systolic function is preserved.

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Section: Discussionsupporting

confidence: 51%

Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre‐eclampsia: a randomised, controlled trial

et al. 2017

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“…A retrospective comparison of ephedrine and phenylephrine for the treatment of hypotension after spinal anaesthesia in women with pre‐eclampsia found no difference in neonatal umbilical artery pH , nor did a further study in high‐risk women that included an unspecified proportion of women with pre‐eclampsia . A recent randomised trial has shown that in patients with severe pre‐eclampsia and fetal compromise, fetal acid–base status is independent of the use of bolus ephedrine vs. phenylephrine to treat spinal hypotension .…”

Section: Special Circumstancesmentioning

confidence: 99%

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

et al. 2017

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Why was this consensus statement developed?Advances in clinical practice are sometimes inhibited by a multitude of different options that need to be selected. There has been significant variation in the treatment of spinal anaesthesia-induced hypotension. These guidelines are designed to provide clinicians with specific best-practice plans that will cover a wide range of drug and equipment availability. Detailed recommendations are provided for the management of hypotension in resource-rich and resource-poor environments.

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“…1) of which finally eight studies, including 712 parturients, were analysed. [18][19][20][21][22][23][24][25] Five studies reported on caesarean section for preeclamptic women and three studies on other high-risk cases. Details of the studies are shown in Table 1.…”

Section: Study Selection Study Characteristics and Risk Of Biasmentioning

confidence: 99%

Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis

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Hilber

Kee

et al. 2019

International Journal of Obstetric Anesthesia

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A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise

Cited by 39 publications

References 15 publications

Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre‐eclampsia: a randomised, controlled trial

Maternal cardiac output response to colloid preload and vasopressor therapy during spinal anaesthesia for caesarean section in patients with severe pre‐eclampsia: a randomised, controlled trial

International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis

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