Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

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

doi:10.1213/01.ane.0000099782.78002.30

Cited by 143 publications

(75 citation statements)

References 24 publications

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“…These haemodynamic effects or findings are in agreement with other studies [8,10,11] indicating that phenylephrine administered as infusion effectively maintains SBP, MAP and DBP, but decreases heart rate during spinal anaesthesia and CSE. 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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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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“…Contemporary articles emphasize on the arterial rather than venous circulation and project the reduced systemic vascular resistance as the primary factor for the genesis of maternal hypotension [6][7][8] . Over the last few years, there is a trend to rely more on vasopressors than either crystalloid or colloid alone 4,6,7 .…”

Section: Issn: 0975-8232mentioning

confidence: 99%

“…Different vasopressors are commonly used at present with varying degrees of success 6 . Despite the use of prophylactic intravenous (i.v.)…”

Section: Issn: 0975-8232mentioning

confidence: 99%

“…infusion 6 or bolus 7 ephedrine for the last three decades, a good number of failures have also been reported 9 and a rescue phenylephrine bolus dose appears effective when ephedrine alone fails to correct hypotension 3 . Prophylactic phenylephrine infusion significantly lowers the incidence of spinal anaesthesia-induced maternal hypotension 6,10 despite its limitations like bradycardia, hypertension and reduced cardiac output at higher dose 3,8 . Advantage of phenylephrine include high efficacy, ease of titration, ability to use liberal doses to maintain maternal blood pressure near normal and prevent nausea and vomiting without causing fetal acidosis.…”

Section: Issn: 0975-8232mentioning

confidence: 99%

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2012

IJPSR

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“…More importantly, when severe and sustained, hypotension can impair uterine and intervillous blood flow and ultimately result in fetal acidosis and neonatal depression [1][2][3][4]. Prevention measures include fluid preload, left lateral tilt, and use of vasopressors [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section

Atashkhoyi¹,

Fardiazar²,

Pouya³

et al. 2012

OJOG

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Background and Objective: The effectiveness of ephedrine and/or phenylephrine, in treatment of hypotension secondary to spinal anesthesia for cesarean section and their effects on fetal/neonatal outcome were studied. Methods and Materials: Sixty healthy parturients were randomly assigned to two groups; group E (n = 33) received boluses 5 mg/ml increments ephedrine and group P (n = 27) received a boluses of phenylephrine 100 µg/ml increments for treatment of hypotension after spinal block during cesarean section. Changes in maternal blood pressure and heart rate, and incidence of nausea-vomiting, neonatal Apgar score at 1 and 5 minutes of delivery, and umbilical arterial blood gas values were recorded. Results: There were no differences in treatment of hypotension following sympathectomy after spinal block with two drugs. Neonatal outcome was similar in two groups. There were not significant differences in umbilical arterial values in two groups. Conclusion: Ephedrine and phenylephrine are both effective vasopressores for treatment of hypotension associated to spinal block during cesarean section without adverse effects on infants/neonates.

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Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

Abstract: In patients receiving spinal anesthesia for elective cesarean delivery, a prophylactic infusion of phenylephrine 100 microg/min decreased the incidence, frequency, and magnitude of hypotension with equivalent neonatal outcome compared with a control group receiving IV bolus phenylephrine.

Cited by 143 publications

References 24 publications

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

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

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Comparison the effect of ephedrine and phenylephrine in treatment of hypotension after spinal anesthesia during cesarean section

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