Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

Kee, Warwick D. Ngan; Lee, Shara W. Y.; Ng, Floria F.; Tan, Perpetua E.; Khaw, Kim S.

doi:10.1097/aln.0000000000000601

Cited by 226 publications

(229 citation statements)

References 33 publications

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“…A study comparing prophylactic infusion of noradrenaline to phenylephrine with the aim of preventing bradycardia and a decrease in CO, found a lower incidence of bradycardia (defined as HR<60 bpm) and a slightly higher mean HR in the noradrenaline group. 130 However, with relatively higher doses needed to keep blood pressure equally stable, lower SVR, and a lasting increase in CO by almost 20% above baseline after the first five minutes, noradrenaline did not have a superior overall haemodynamic effect compared to phenylephrine. Bradycardia and an associated decrease in CO are often the result of overtreated blood pressure, hence a β-effect as from noradrenaline is usually unnecessary in healthy parturients.…”

Section: Effect Of Phenylephrine and Leg Wrapping On Overall Haemodynmentioning

confidence: 84%

Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Kuhn

Hauge

Rosseland

et al. 2016

Anesthesia &Amp; Analgesia

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An initial bolus of phenylephrine followed by a low-dose phenylephrine infusion was superior to leg wrapping and no intervention for the prevention of hypotension during spinal anesthesia for cesarean delivery. Phenylephrine prevented hypotension primarily by restoring systemic vascular resistance and did not cause hypertension or a clinically relevant reduction in cardiac output. Leg wrapping prevented hypotension compared with no intervention by limiting modest early spinal anesthesia-mediated venodilation.

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Section: Effect Of Phenylephrine and Leg Wrapping On Overall Haemodynmentioning

confidence: 84%

Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Kuhn

Hauge

Rosseland

et al. 2016

Anesthesia &Amp; Analgesia

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“…Despite the previously documented exaggerated response to spinal anaesthesia in females, [19][20][21][22] the effectiveness of NE infusion for maintaining blood pressure with associated greater heart rate and cardiac output than with phenylephrine during SA for Caesarean section, as documented in the literature, [23][24][25] could be considered as support for the results of the current study.…”

Section: Discussionmentioning

confidence: 60%

Nor-epinephrine versus vasopressin infusion for prevention of spinal-induced hypotension: a placebo-controlled study

Mohamed

Safan

2017

Southern African Journal of Anaesthesia and Analgesia

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Objectives:To evaluate the prophylactic effect of norepinephrine (NE) and vasopressin (VP) infusion on frequency and severity of spinal anaesthesia-induced hypotension (SAIH). Patients and methods: A total of 240 young male patients were randomly allocated into three equal groups: Group C received plain saline infusion, Group NE received NE infusion (0.1 mg/ml; 3 ml/h) and Group VP received VP infusion (0.5 U/ml; 1 U/h); all infusions started synchronously with spinal injection (SI). Systolic arterial pressure (SAP) and heart rate (HR) measures were determined at 1, 4, 7 and 10-min; then every 5-min for 30 min. SAP reduction of >10% was treated by supplementary fluid therapy and resistant cases or patients who had SAP reduction of ≥20% received ephedrine (10 mg). Results: In comparison with baseline SAP, SAP was decreased by > 20% in eight control patients, by < 10% in 22 patients and in 50 control patients SAP decrease ranged between 10% and 20%. In the NE and VP groups, no patient had decreased SAP of > 10%, while 15 patients had increased SAP of > 10% and 145 patients showed no SAP change with significant difference between the two groups (p = 0.0003). Throughout the 30 min after spinal block, all SAP and HR measures of control patients were significantly (p = 0.001) lower compared with their baseline measures and with corresponding measures of patients of the NE and VP groups with non-significant difference between the two groups. Seven patients (8.8%) in the control group had nausea and three (3.8%) had nausea and vomiting, while no patient in the NE and VP groups had nausea or required anti-emetic therapy. Conclusion: Vasopressor infusion given synchronously with spinal injection is an appropriate prophylactic policy against SAIH. NE infusion did better than VP infusion and provided better haemodynamic stability after spinal injection. However, VP infusion allowed control of blood pressure despite the significant decrease till 7 min after SI.

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“…[31] Norepinephrine has been shown to have similar efficacy for maintaining blood pressure, with smaller incidence of bradycardia. [32] …”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of cesarean delivery in parturients with ruptured sinus of Valsalva aneurysm

Fang¹,

Li²,

et al. 2017

Medicine

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Rationale:Ruptured sinus of Valsalva aneurysm is rare and dangerous in parturients. Few cases of ruptured SVA in pregnancy are reported, and the anesthetic management for cesarean delivery has scarcely been described.Patient concerns:A parturient at 37-week gestation complained of a sore throat and cough that started 3 days before admission, followed 1 day later by fever, dizziness, breathlessness, and palpitation on exertion. Case two at 36-week gestation complained of a 1-day history of bloating in the lower abdomen.Diagnoses:Full term and preterm parturients with ruptured sinus of Valsalva aneurysm.Interventions:Cesarean deliveries were performed with incremental epidural anesthesia technique under invasive monitoring. Surgical correction of the ruptured sinus of Valsalva aneurysms and ventricular septal defect were performed uneventfully 13 days and 7 days postpartum, respectively, for the 2 cases.Outcomes:No complications were observed in the intra- or postoperative period for both mothers and babies.Lessons:We reviewed the pertinent literature and reached the following conclusions: use of a multidisciplinary team to guide anesthetic management is helpful and necessary; and both general anesthesia and incremental epidural anesthesia can be safely used in parturients with ruptured sinus of Valsalva aneurysm.

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Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

Cited by 226 publications

References 33 publications

Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Hemodynamics of Phenylephrine Infusion Versus Lower Extremity Compression During Spinal Anesthesia for Cesarean Delivery

Nor-epinephrine versus vasopressin infusion for prevention of spinal-induced hypotension: a placebo-controlled study

Anesthetic management of cesarean delivery in parturients with ruptured sinus of Valsalva aneurysm

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