Retrospective study of association between choice of vasopressor given during spinal anaesthesia for high-risk caesarean delivery and fetal pH

Cooper, David W.; Sharma, S.; Orakkan, P.; Gurung, Sunita

doi:10.1016/j.ijoa.2009.06.002

Cited by 29 publications

(20 citation statements)

References 17 publications

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“…26 Larger doses of ephedrine are associated with maternal symptoms like tachycardia and nausea and vomiting as reported by many authors. 26,27 We observed an increase in maternal HR in all patients receiving ephedrine but the incidence of nausea and vomiting was low (11.5%). None of the patients required treatment for this nausea and vomiting.…”

mentioning

confidence: 72%

“…In this study, no neonate had an Apgar score < 7 at 1 or at 5 minutes. 27 Adigun and Amnaor-Boadu in their study compared intravenous ephedrine with phenylephrine for the maintenance of arterial blood pressure during elective caesarean section under spinal anesthesia. The mean Apgar scores were similar for the two groups; no baby had Apgar score of <8 in either group.…”

mentioning

confidence: 99%

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Comparison Between Phenylephrine, Ephedrine And Mephentermine In Preventing Hypotension During Spinal Anesthesia For Caesarean Section And Their Effect On Fetal Outcome.

Lonkar¹,

Khatavkar²,

Thatte³

et al. 2016

IOSR

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mentioning

confidence: 72%

mentioning

confidence: 99%

Comparison Between Phenylephrine, Ephedrine And Mephentermine In Preventing Hypotension During Spinal Anesthesia For Caesarean Section And Their Effect On Fetal Outcome.

Lonkar¹,

Khatavkar²,

Thatte³

et al. 2016

IOSR

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“…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%

“…52 These results were confirmed in a recent retrospective study that included patients with various comorbidities. 42 No study has evaluated the effects of a phenylephrine infusion on fetal variables in human subjects. In circumstances where a marginal (or insufficient) utero-placental flow is suggested by a ''non-reassuring'' fetal heart rate tracing, any situation causing an additional decrease in flow should be avoided.…”

Section: Emergency Cesarean Deliveriesmentioning

confidence: 99%

“…40 Certaines études font ressortir une tendance vers une PaO 2 de sang veineux de cordon plus basse lorsque les mères reçoivent de la phényléphrine. 39,40,42 Ces résultats pourraient s'expliquer par un effet vasoconstricteur de la phényléphrine sur le réseau vasculaire utéroplacentaire et conséquemment par une augmentation de l'extraction foetale en oxygène. 40 Cette capacité à augmenter l'extraction en oxygène conférerait une certaine « marge de sécurité » face à une diminution du débit sanguin utéroplacentaire dans les grossesses normales.…”

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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Fetal Distress

Dyer

MBChB

2012

Anesthesia and the Fetus

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Retrospective study of association between choice of vasopressor given during spinal anaesthesia for high-risk caesarean delivery and fetal pH

Cited by 29 publications

References 17 publications

Comparison Between Phenylephrine, Ephedrine And Mephentermine In Preventing Hypotension During Spinal Anesthesia For Caesarean Section And Their Effect On Fetal Outcome.

Comparison Between Phenylephrine, Ephedrine And Mephentermine In Preventing Hypotension During Spinal Anesthesia For Caesarean Section And Their Effect On Fetal Outcome.

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

Fetal Distress

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