A Randomized, Double-blinded Comparison of Phenylephrine and Ephedrine Infusion Combinations to Maintain Blood Pressure During Spinal Anesthesia for Cesarean Delivery: The Effects on Fetal Acid-Base Status and Hemodynamic Control

Kee, Warwick D. Ngan; Lee, A.; Khaw, Kim S.; Ng, Floria F.; Karmakar, Manoj K.; Gin, Tony

doi:10.1097/01.aoa.0000358410.78531.07

Cited by 45 publications

(65 citation statements)

References 17 publications

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“…(58) With the use of phenylephrine boluses, it was easier to keep the values of haemodynamic parameters closer to baseline values, (59) as it had a faster onset and could be more accurately titrated than other vasoactive drugs. (60) Besides hypotension, other common sideeffects related to hypotension were nausea, vomiting, and dizziness with incidences of around 25%. (61) In our study, the incidence of nausea in group H was 25%, whereas in group L it was 5%, the difference between the groups was not significant.…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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Background. For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods. In a prospective, randomized study 44 American Society of Anaesthesiologists (ASA) 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results. The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant difference in haemodynamic variables

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Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Poredoš¹,

Novak-Jankovič²

2017

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“…However, many studies showed in elective Cesarean deliveries that giving ephedrine resulted in more fetal acidosis than phenylephrine. 12,[38][39][40][41] In a key study by Ngan Kee et al, the authors performed umbilical cord arterial blood gas analysis; they showed a significant decrease in pH, base excess and oxygen content, as well as an increase in neonatal PaCO 2 if the parturient had received large doses of ephedrine. 39 It is also important to note that in all the newborns in the study, none of the Apgar scores at one and five minutes was less than 7 and 9, respectively.…”

Section: Vasopressorsmentioning

confidence: 99%

“…12,[38][39][40][41] In a key study by Ngan Kee et al, the authors performed umbilical cord arterial blood gas analysis; they showed a significant decrease in pH, base excess and oxygen content, as well as an increase in neonatal PaCO 2 if the parturient had received large doses of ephedrine. 39 It is also important to note that in all the newborns in the study, none of the Apgar scores at one and five minutes was less than 7 and 9, respectively. These results can be explained by a more important placental transfer of ephedrine than phenylephrine, and possibly by a fetal b-adrenergic stimulating effect of ephedrine, as evidenced by higher serum lactate, glucose and epinephrine levels in newborns of mothers who had received ephedrine.…”

Section: Vasopressorsmentioning

confidence: 99%

“…40 In some studies, there are trends towards a lower PaO 2 values in the umbilical cord venous blood when mothers receive phenylephrine. 39,40,42 These findings may be a result of the vasoconstrictor effect of phenylephrine on utero-placental vessels, and a subsequent increased oxygen extraction by the fetus. 40 The possibility to extract more oxygen would provide a certain ''safety margin'' in the event of compromised utero-placental blood flow during normal pregnancy.…”

Section: Vasopressorsmentioning

confidence: 99%

“…Plusieurs études ont cependant démontré qu'en césarienne programmée, l'administration d'éphédrine résultait en une acidose foetale plus importante que l'administration de phényléphrine. 12,[38][39][40][41] Les résultats de l'analyse du sang artériel de cordon ombilical obtenus dans une étude phare menée par Ngan Kee et coll. ont démontré une diminution statistiquement significative du pH, de l'excès de base et du contenu en oxygène ainsi qu'une augmentation de la PaCO 2 chez les nouveau-nés de parturientes recevant une dose élevée d'éphédrine.…”

Section: Les Vasopresseursunclassified

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Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

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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An Adaptive Monitoring Scheme for Automatic Control of Anaesthesia in dynamic surgical environments based on Bispectral Index and Blood Pressure

Doctor

Fan

et al. 2018

J Med Syst

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During surgical procedures, bispectral index (BIS) is a well-known measure used to determine the patient's depth of anesthesia (DOA). However, BIS readings can be subject to interference from many factors during surgery, and other parameters such as blood pressure (BP) and heart rate (HR) can provide more stable indicators. However, anesthesiologist still consider BIS as a primary measure to determine if the patient is correctly anaesthetized while relaying on the other physiological parameters to monitor and ensure the patient's status is maintained. The automatic control of administering anesthesia using intelligent control systems has been the subject of recent research in order to alleviate the burden on the anesthetist to manually adjust drug dosage in response physiological changes for sustaining DOA. A system proposed for the automatic control of anesthesia based on type-2 Self Organizing Fuzzy Logic Controllers (T2-SOFLCs) has been shown to be effective in the control of DOA under simulated scenarios while contending with uncertainties due to signal noise and dynamic changes in pharmacodynamics (PD) and pharmacokinetic (PK) effects of the drug on the body. This study considers both BIS and BP as part of an adaptive automatic control scheme, which can adjust to the monitoring of either parameter in response to changes in the availability and reliability of BIS signals during surgery. The simulation of different control schemes using BIS data obtained during real surgical procedures to emulate noise and interference factors have been conducted. The use of either or both combined parameters for controlling the delivery Propofol to maintain safe target set points for DOA are evaluated. The results show that combing BIS and BP based on the proposed adaptive control scheme can ensure the target set points and the correct amount of drug in the body is maintained even with the intermittent loss of BIS signal that could otherwise disrupt an automated control system.

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A Randomized, Double-blinded Comparison of Phenylephrine and Ephedrine Infusion Combinations to Maintain Blood Pressure During Spinal Anesthesia for Cesarean Delivery: The Effects on Fetal Acid-Base Status and Hemodynamic Control

Cited by 45 publications

References 17 publications

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

An Adaptive Monitoring Scheme for Automatic Control of Anaesthesia in dynamic surgical environments based on Bispectral Index and Blood Pressure

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