Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section

Saravanan, S.; Kocarev, Mitko; Wilson, Robert R.; Watkins, Elizabeth J.; Columb, Malachy O.; Lyons, G.

doi:10.1093/bja/aei265

Cited by 156 publications

(117 citation statements)

References 27 publications

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“…Based on our clinical experience, we chose doses that we considered to be approximately equipotent. However, subsequent to the commencement of our study, Saravanan et al [17] published data from which they estimated that the potency ratio of phenylephrine:ephedrine was approximately 80 : 1 (phenylephrine 100 lg = ephedrine 8 mg) when the drugs were given by infusion. Although this suggests that the doses in our study might not have been be exactly equipotent, nonetheless the doses we used fall within what we consider a normal clinical range and we do not consider that the exact choice of dose would have had an important influence on the study results.…”

Section: Discussionmentioning

confidence: 88%

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Kee

Khaw

Lau³

et al. 2008

Anaesthesia

106

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SummaryIn a randomised, double-blinded study, we compared boluses of phenylephrine 100 lg with ephedrine 10 mg for treating hypotension (systolic blood pressure < 100 mmHg) in 204 patients having non-elective Caesarean section under spinal anaesthesia. Umbilical arterial (UA) and venous (UV) pH and base excess were similar between groups. In the ephedrine group, UA lactate concentration was higher (median 2.6 [interquartile range 2.

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Section: Discussionmentioning

confidence: 88%

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Kee

Khaw

Lau³

et al. 2008

Anaesthesia

106

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“…Spinal anesthesia is known as a standard technique for elective C-section due to its cost effectiveness and less amount of surgical hemorrhage [16,17]. However, the incidence of…”

Section: Discussionmentioning

confidence: 99%

Comparison of ephedrine and phenylephrine in incidence of headache during spinal anesthesia in cesarean delivery

Yari¹,

Choubsaz²,

Farzam³

et al. 2018

biomedicalresearch

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Background: Spinal anesthesia is more acceptable method of anesthesia in elective cesarean section, but hypotension is the major limitation of this technique which might trigger to serious complications for both mother and fetus. The use of vasopressors is necessary to control hypotension caused by spinal anesthesia, however, it might be along with side effects like headache. Methods: In the present study, 105 candidates for elective cesarean delivery were assessed to compare the role of ephedrine and phenylephrine in relation with the incidence of headache. Pearson Chi-square test, Kruskal-Wallis test, Spearman's rho correlation coefficient was performed to analyse the data. P value<0.05 was considered significant. All data were analysed using Stata 12. Results: The incidence of headache during the surgery was 51.4%, 45.7% and 37.1% in ephedrine, phenylephrine and control groups respectively. Not a significant difference was found between ephedrine and phenylephrine regarding the incidence of headache (P=0.541), also no significant difference were found in the severity of the headache (P=0.277). The severity of the headache was not different 24 h after surgery. The number of doses of vasopressor consumption in ephedrine and phenylephrine recipients was not significantly different (P=0.579). No significant difference was found between the number of doses used and the severity of the headache during surgery (P=0.979). However, the average of systolic blood pressure in ephedrine group was higher than phenylephrine group (P=0.001). Also, the impact of ephedrine and phenylephrine on heart rate was similar and affectless. Conclusions: In this study, no significant differences were observed in the incidence and severity of headaches during and after surgery, and the number of doses of vasopressor drug consumption between phenylephrine and ephedrine recipients to treat hypotension associated with spinal anesthesia in cesarean section.

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“…NganKee and colleagues [12] demonstrated that in patients receiving spinal anaesthesia for Caesarean section, a prophylactic infusion of phenylephrine 100 μg/min given immediately after initiation of spinal block decreased the incidence, frequency and magnitude of hypotension compared with a control group receiving intravenous bolus of 100 μg phenylephrine given as treatment for episodes of hypotension. The lower dose of phenylephrine used in this study was to ensure a relative potency of 80:1 based on the study by Saravanet al [13].…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Infusions of Phenylephrine and Ephedrine during Combined Spinal Epidural Anaesthesia for Caesarean Section: A Comparative Study

S¹

2013

J Anesth Clin Res

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Background: Hypotension is the most common adverse effect in parturients after spinal anaesthesia for Caesarean section. Despite various pharmacological and non-pharmacological methods used in its prevention and treatment, vasopressors have become very important in the management of this form of hypotension.Objective: This study was aimed at comparing the efficacy and safety of prophylactic intravenous infusions of phenylephrine and ephedrine at preventing maternal hypotension during Combined Spinal Epidural anaesthesia (CSE) for Caesarean section.Methods: Sixty ASA I and II patients scheduled for elective Caesarean section, were randomly allocated into two groups. Patients in Group I received Phenylephrine 80 μg/min while patients in Group II received Ephedrine 1 mg/min immediately after the subarachnoid 10 mg plain bupivacaine injection while the epidural catheter was being inserted and secured. All the patients received a crystalloid preload of 1 litre of 0.9% normal saline prior to the induction of CSE. Results:The overall incidence of hypotension was 8.5% (6.7% in the phenylephrine group and 10.3% in the ephedrine groups). The lowest systolic (105.8 ± 9.2 mmHg) and diastolic arterial pressures (60.9 ± 8.9 mmHg) occurred in the ephedrine group while the lowest heart rates occurred in the phenylephrine group. The mean umbilical artery pH was 7.3 while Apgar scores at 1 st and 5 th min were essentially the same in the two groups. Conclusion:Prophylactic intravenous infusions of phenylephrine and ephedrine are safe and effective at reducing the incidence and severity of hypotension during combined spinal epidural anaesthesia for elective Caesarean section with no associated neonatal acidosis.

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Equivalent dose of ephedrine and phenylephrine in the prevention of post-spinal hypotension in Caesarean section

Abstract: This study demonstrates a potency ratio of 81.2 (95% CI 73.0-89.7) for equivalence between phenylephrine and ephedrine in prevention of hypotension after spinal anaesthesia for Caesarean section.

Cited by 156 publications

References 27 publications

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Randomised double‐blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non‐elective Caesarean section*

Comparison of ephedrine and phenylephrine in incidence of headache during spinal anesthesia in cesarean delivery

Prophylactic Infusions of Phenylephrine and Ephedrine during Combined Spinal Epidural Anaesthesia for Caesarean Section: A Comparative Study

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