The effect of the intravenous phenylephrine on the level of spinal anesthesia

Tahir²,

et al. 2019

Int J Res Med Sci

Background: During caesarean section hypotension due to spinal block is secondary to the sympathetic blockade and aorto-caval compression by the uterus. It can have important consequences for the mother and may affect neonatal outcome. The present study was aimed to compare intravenous bolus doses of phenylephrine and ephedrine to treat maternal hypotension during spinal block for elective caesarean section.Methods: After fulfilling the inclusion criteria, 100 parturient were randomly allocated into two groups of fifty each. For spinal anesthesia lumber puncture was done and 12.5mg, 0.5% hyperbaric bupivacaine was given intra-thecally. In this observational study, patients who developed hypotension under spinal anesthesia were selected for the study. According to their group, patients received either ephedrine 6mg (Group E) or phenylephrine 75µg (Group P) as vasopressor. During the study, number of vasopressor boluses, hemodynamic response and time taken to recover from hypotension was noted.Results: Ephedrine and phenylephrine were used in the mean doses of 6.72±1.97mg and 91.5±31.38µg respectively. In 88% parturient single bolus dose of ephedrine was effective in treating hypotension while phenylephrine was effective in 78% parturient. There was no significant difference observed in total number of boluses used. No significant difference was seen in mean systolic blood pressure, mean diastolic blood pressure and mean arterial pressure over a given period of time in Group E and Group P. Mean systolic BP was less than 20% when compared to baseline in both the groups at different time intervals. In Group P the mean heart rate was significantly lower as compared to the Group E (p<0.05).Conclusions: Intravenous phenylephrine and ephedrine are both similar in performance in treating hypotension after spinal anesthesia for elective caesarean section and the hypotensive control offered is comparable.

Section: Discussioncontrasting

confidence: 95%

Comparison of commonly used vasopressors for treating hypotension after spinal anaesthesia in elective lower abdominal surgery: a randomized, observational, case-control study

Tahir²,

et al. 2019

Int J Res Med Sci

“…Despite the fact that the use of epinephrine is not associated with an elevated risk of TNS 15 , it has been linked to a case of cauda equina syndrome in one study 16 The usage of phenylephrine has been associated with an increased risk of TNS (10-fold increase) 17 .…”

Section: Discussionmentioning

confidence: 94%

Comparison of Hemodynamics Effect between Phenylephrine and Ephedrine in Caesarean Section after Spinal Anesthesia

Nazir¹,

Khan²,

Faisal³

et al. 2021

PJMHS

Aim: To compare the frequency of hypotension between phenylephrine and ephedrine groups after spinal anesthesia for cesarean delivery. Study design: Single-blind randomized clinical study Place and duration of study: Department of Anesthesia, Pain Management and Surgical ICU Civil Hospital, Karachi from 1st January 2019 to 30th June 2019. Methodology: All patients with age between 18 to 35 years having weight range 50kg to70kg with American Society of Anesthesiologist (ASA) physical classification of I and II with Singleton Pregnancy assessed on ultrasound and gestational age 37 to 42 weeks assessed on previous dating scan were enrolled. Results: The mean age was 26.48±3.05 years, mean weight was 60.07±5.10 Kg, mean height 1.53±0.05m and mean BMI was 27.37±5.01 Kg/m2 respectively. Hypotension was found in 13(17.10%) patients. Comparison of hypotension with pehenylephrine and ephedrine shows that frequency of hypotension was found lower (15.4%) in patients who used pehenylephrine as compared to the patients who used ephiderine (p=0.006). Conclusion: Significant difference was observed in hypotension between phenylephrine and ephedrine groups after spinal anesthesia for cesarean delivery. Keywords: Hypotension, cesarean delivery, phenylephrine and ephedrine groups, spinal anesthesia

“…The results of this study were in accordance with the study of other investigators in which they reported higher incidence of bradycardia in patients receiving phenylephrine as compared with patients receiving ephedrine for prevention of hypotension during spinal anesthesia for cesarean section. [ 10 11 12 ]…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays spinal anesthesia is widely used for elective lower abdominal surgeries. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ] It is frequently accompanied by hypotension, which may be defined in absolute terms as a systolic blood pressure (SBP) less than 90 or 100 mmHg or in relative terms as a percentage (20% fall from baseline). [ 1 ] The severity of this hypotension depends on the height of the block, the position of the patient, and the volume status of them.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Intravenous Ephedrine or Phenylephrine, for Prevention of Postspinal Hypotension during Elective Lower Abdominal Surgery: A Randomized, Double-blind Case–control Study

2017

Background:In this randomized, double-blinded case–control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post–spinal hypotension in elective lower abdominal surgery under spinal anesthesia.Materials and Methods:One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each). According to their allocated group, patients received either ephedrine 2.5 mg (E group), phenylephrine (P group) 25 mic as vasopressor or the same volume of saline normal as placebo (S group) immediately after the spinal anesthesia. hemodynamic parameters, and complications were recorded.Results:Patients’ demographics were similar in all the groups. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP and also heart rate were similar over time for groups E and P (P > 0.05). The incidence of reactive hypertension was more in group E than group P and placebo (P < 0.05). The incidence of nausea and vomiting were significantly lower in groups E and P in comparison with placebo (P < 0.05).Conclusion:Although the mean fall of SBP and DBP were significantly less in groups E and P compared with placebo but we did not find significant differences in prophylactic use of ephedrine or phenylephrine for prevention of post–spinal hypotension in elective lower abdominal surgery. Vasopressors infusion have added benefit of lower incidence of nausea and vomiting.