The Dose-Dependent Effects of Phenylephrine for Elective Cesarean Delivery Under Spinal Anesthesia

Stewart, Adrienne; Fernando, Roshan; McDonald, Sarah; Hignett, Rachel; Jones, Tanya; Columb, Malachy O.

doi:10.1213/ane.0b013e3181f2eae1

Cited by 210 publications

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References 20 publications

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“…Les conséquences de cette approche pourraient être une incidence plus élevée d'hypertension réactive 2 et, possiblement, une réduction temporaire du débit cardiaque. 12 Bien que ces effets ne soient pas désirables, à ce jour aucune association n'a été démontrée entre leur survenue et des dommages mesurables. L'alternative, en revanche, soit les nausées et vomissements peropératoires associés à l'hypotension, est clairement indésirable.…”

Section: La Prévention Des Nausées Etunclassified

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Preventing hypotension-induced nausea and vomiting during spinal anesthesia for Cesarean delivery in obese parturients: a small solution for a big problem?

Kee

2017

Can J Anesth/J Can Anesth

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Section: La Prévention Des Nausées Etunclassified

“…The consequences of this approach may be a higher incidence of reactive hypertension 2 and possibly a transient decrease in cardiac output. 12 Although the latter effects are not desirable, they have not yet been shown to be associated with measurable harm. In contrast, the alternative, hypotension-associated IONV, is clearly undesirable.…”

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confidence: 99%

Preventing hypotension-induced nausea and vomiting during spinal anesthesia for Cesarean delivery in obese parturients: a small solution for a big problem?

Kee

2017

Can J Anesth/J Can Anesth

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“…49 Through its predominant a-adrenergic activity, phenylephrine causes an increase in peripheral vascular resistance that can lead to a reflex maternal bradycardia, and decreased cardiac output. 8,16 Ultimately, the total dose of phenylephrine by infusion usually exceeds 1,000 lg, significantly more than the total of bolus doses. 46,49 In healthy parturients undergoing elective Cesarean delivery, the clinical importance of these drawbacks appears to be negligible as phenylephrine, even with high doses, does not cause fetal acidosis, nor neonatal cardiovascular or respiratory depression.…”

Section: Vasopressorsmentioning

confidence: 99%

“…Enfin, dans une étude récente dans laquelle le débit cardiaque était réduit de 1 LÁmin -1 sous les niveaux de base, l'administration d'une perfusion de phényléphrine n'a pas entraîné d'effet délétère sur le pH artériel ombilical ni le score Apgar des nouveau-nés. 16 Ces éléments suggèrent que dans les cas de césariennes programmées, le débit sanguin régional utéroplacentaire et l'apport en oxygène dépassent probablement de façon significative les besoins foetaux en oxygène et qu'une certaine baisse du débit sanguin maternel peut être tolérée par le foetus.…”

Section: Implications Cliniques De L'hypotension Artérielleunclassified

“…Lastly, in a recent study where cardiac output decreased by 1 LÁmin -1 below baseline, a phenylephrine infusion did not produce any deleterious effects on the umbilical arterial pH or neonatal Apgar scores. 16 These elements suggest that in the case of elective Cesarean deliveries, regional utero-placental blood flow and oxygen supply are likely to exceed fetal oxygen demand significantly, and a limited decrease in maternal blood flow can be tolerated by the fetus. …”

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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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Techniques for preventing hypotension during spinal anaesthesia for caesarean section

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Cox

Lumb

et al. 2017

Cochrane Database of Systematic Reviews

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The Dose-Dependent Effects of Phenylephrine for Elective Cesarean Delivery Under Spinal Anesthesia

Cited by 210 publications

References 20 publications

Preventing hypotension-induced nausea and vomiting during spinal anesthesia for Cesarean delivery in obese parturients: a small solution for a big problem?

Preventing hypotension-induced nausea and vomiting during spinal anesthesia for Cesarean delivery in obese parturients: a small solution for a big problem?

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

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

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