Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section †

Kee, Warwick D. Ngan; Khaw, Kim S.; Ng, Floria F.

doi:10.1093/bja/aeh088

Cited by 221 publications

(89 citation statements)

References 15 publications

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“…Our findings are consistent with recent published data on management of maternal hypotension during spinal anesthesia [9][10][11][12][13][14][15][16][17][18] . Mercier FJ et al, 2007 16 analysed the different preventive and curative strategies for management of hypotension during spinal anaesthesia for cesarean section.…”

Section: Resultssupporting

confidence: 93%

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2012

IJPSR

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Section: Resultssupporting

confidence: 93%

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2012

IJPSR

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“…Our analyses pointed out that some obstetric factors such as the usage of oxytocin and forceps may be associated with nausea and vomiting which are common during delivery. Studies showed that the occurance of nausea and vomiting is correlated to the degree of hypotension [36]. Higher doses of oxytocin or forceps delivery may lead to sudden haemodynamic change.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Lin

Tao

et al. 2014

PLoS ONE

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Remifentanil with appropriate pharmacological properties seems to be an ideal alternative to epidural analgesia during labour. A retrospective cohort study was undertaken to assess the efficacy and safety of remifentanil intravenous patient-controlled analgesia (IVPCA) compared with epidural analgesia. Medical records of 370 primiparas who received remifentanil IVPCA or epidural analgesia were reviewed. Pain and sedation scores, overall satisfaction, the extent of pain control, maternal side effects and neonatal outcome as primary observational indicators were collected. There was a significant decline of pain scores in both groups. Pain reduction was greater in the epidural group throughout the whole study period (0∼180 min) (P<0.0001), and pain scores in the remifentanil group showed an increasing trend one hour later. The remifentanil group had a lower SpO2 (P<0.0001) and a higher sedation score (P<0.0001) within 30 min after treatment. The epidural group had a higher overall satisfaction score (3.8±0.4 vs. 3.7±0.6, P = 0.007) and pain relief score (2.9±0.3 vs. 2.8±0.4, P<0.0001) compared with the remifentanil group. There was no significant difference on side effects between the two groups, except that a higher rate of dizziness (1% vs. 21.8%, P<0.0001) was observed during remifentanil analgesia. And logistic regression analysis demonstrated that nausea, vomiting were associated with oxytocin usage and instrumental delivery, and dizziness was associated to the type and duration of analgesia. Neonatal outcomes such as Apgar scores and umbilical-cord blood gas analysis were within the normal range, but umbilical pH and base excess of neonatus in the remifentanil group were significantly lower. Remifentanil IVPCA provides poorer efficacy on labor analgesia than epidural analgesia, with more sedation on parturients and a trend of newborn acidosis. Despite these adverse effects, remifentanil IVPCA can still be an alternative option for labor analgesia under the condition of one-to-one bedside care, continuous monitoring, oxygen supply and preparation for neonatal resuscitation.

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“…[10] The prediction of obstetric spinal hypotension has received considerable attention and has recently been the subject of review in a local journal. [11] While a number of practical predictors such as body mass index, maternal age and baseline heart rate have shown potential, results have been conflicting and applied predominantly to elective patients.…”

Section: Prediction Of Obstetric Spinal Hypotensionmentioning

confidence: 99%

“…Initial work using high phenylephrine infusion rates (100 µg/min) and aggressive fluid coloading showed that hypotension could be almost eliminated, but at the cost of reactive hypertension. [10,19] Subsequent work with lowerdose phenylephrine infusions supported prophylactic infusions as part of routine CS. [14] Further dosefinding studies suggested that a range of 25 50 µg/min seemed to give the most benefit with the fewest sideeffects.…”

Section: Vasopressor Management Strategiesmentioning

confidence: 99%

Recipes for obstetric spinal hypotension: The clinical context counts

2016

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Hypotension following obstetric spinal anaesthesia remains a common and important problem. While recent research advances have brought us closer to the perfect recipe for the obstetric spinal anaesthetic, these advances have not been translated into practical guidelines able to reduce the unacceptable number of fatalities that occur in environments where resources are limited. In South Africa, more than half of anaesthetic deaths are still related to spinal hypotension. A gap exists between the 'perfect recipe' , developed from a clinical context rooted in resourcerich research environments, and its application and performance in realworld resourcepoor environments -conditions experienced by more than 75% of the world's population. This review attempts to define this knowledge gap and proposes a research agenda to address the deficiencies.

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Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section †

Abstract: For optimal management, phenylephrine should be titrated to maintain maternal BP at near-baseline values.

Cited by 221 publications

References 15 publications

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Intravenous Remifentanil versus Epidural Ropivacaine with Sufentanil for Labour Analgesia: A Retrospective Study

Recipes for obstetric spinal hypotension: The clinical context counts

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