The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section

Lee, Hwa-Mi; Kim, S.-H.; Hwang, Bo-Young; Yoo, Byoung-woo; Koh, Won Uk; Jang, Dong-Min; Choi, Woo-Young

doi:10.1016/j.ijoa.2015.08.009

Cited by 24 publications

(23 citation statements)

References 22 publications

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“…We included 109 out of 1021 retrieved trials, which included 8561 women (Fig. and see also Supporting Information, Table S1) . Twelve interventions (eleven active treatments and one inactive control) to prevent intra‐operative hypotension were studied, with 30 direct comparisons (see also Supporting Information, Table S2).…”

Section: Resultsmentioning

confidence: 99%

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

et al. 2019

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Summary Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta‐analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04–0.26); norepinephrine 0.13 (0.06–0.28); phenylephrine 0.18 (0.11–0.29); leg compression 0.25 (0.14–0.43); ephedrine 0.28 (0.18–0.43); colloid given before induction of anaesthesia 0.38 (0.24–0.61); angiotensin 2, 0.12 (0.02–0.75); colloid given after induction of anaesthesia 0.52 (0.30–0.90); mephentermine 0.09 (0.01–1.30); crystalloid given after induction of anaesthesia 0.78 (0.46–1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76–1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07–0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47–1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.

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Section: Resultsmentioning

confidence: 99%

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

et al. 2019

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“…Our primary outcome is the frequency of post-spinal hypotension. According to previous reports [5] the frequency of maternal hypotension was 37% in mothers who received the same PE bolus. Using G-power Software (version 3.1.9.2), a sample size of 170 participants was calculated to detect a difference of 20% in the frequency of hypotension, with a study power of 80%, and alpha error of 0.05.…”

Section: Methodsmentioning

confidence: 93%

“…Phenylephrine (PE) is still the most commonly used vasopressor during cesarean delivery [3, 4]; however, the most appropriate protocol for PE administration is still unknown. PE is usually administered as single shot [5], fixed (on-off) rate infusion [6], or variable rate infusion [7]. The objective of all protocols is to achieve the least possible incidence of maternal hypotension, and avoiding reactive hypertension, with the least number of physician interventions.…”

Section: Introductionmentioning

confidence: 99%

Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial

et al. 2019

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BackgroundPhenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery.MethodsA randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes.ResultsTwo-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable.ConclusionBoth phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.

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“…Due to variable results in different studies on neonates and mothers regarding these 2 vasopressors, the optimal dose of bolus ephedrine and phenylephrine has not yet been determined (9). This study aimed at investigating the effectiveness of different doses of phenylephrine and ephedrine in the treatment of maternal hypotension during spinal anesthesia for elective cesarean section delivery.…”

Section: Objectivesmentioning

confidence: 99%

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

Vakili¹,

Enayati²,

Dashipour³

2017

Iran Red Crescent Med J

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The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section

Cited by 24 publications

References 22 publications

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

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