Vasopressors in obstetrics: what should we be using?

Kee, Warwick D. Ngan; Khaw, Kim S.

doi:10.1097/01.aco.0000192816.22989.ba

Cited by 117 publications

(39 citation statements)

References 53 publications

(34 reference statements)

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“…[28] that fetal umbilical pH was lower in parturients who received ephedrine than in those who received phenylephrine. Furthermore, phenylephrine has been used for quite some time as an alternative agent for the treatment of hypotension after spinal anesthesia in Cesarean sections or in cases where ephedrine was ineffective [21, 33]. Animal models with compromised fetuses suggest that phenylephrine does not increase fetal lactate concentrations [16].…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, ephedrine has been the vasopressor used most often in North America as it reliably prevents maternal hypotension, while mephentermine is used commonly in many Asian countries including India [11, 19]. Conversely, ephedrine has been implicated in lower umbilical pH levels, especially when used in dosages high enough to stem nausea and vomiting related to hypotension [20, 21]. Recent studies have indicated a decrease in side effects related to vasopressors, such as nausea and vomiting, and increased uteroplacental blood flow with the use of phenylephrine [17, 22].…”

Section: Introductionmentioning

confidence: 99%

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Original research Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Gunda¹,

Malinowski²,

Tegginmath³

et al. 2010

aoms

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A b s t r a c tIntroduction: Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia. Material and methods: The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n = 50). Group P received 1 ml phenylephrine (100 μg/ml) with normal saline if hypotension developed (n = 50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4,6,8,10,15,20,25,30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups. Results: All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group. Conclusions: Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Original research Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Gunda¹,

Malinowski²,

Tegginmath³

et al. 2010

aoms

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“…It is highly effective, easily titratable, and safe for the baby. [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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“…Among the vasopressors phenylephrine is the most effective and safe vasopressor for CS. [20] Left uterine displacement by inserting a wedge under the right lower back and physical interventions such as leg wrapping to minimize venous pooling of blood in the legs can be done. [2122]…”

Section: Discussionmentioning

confidence: 99%

Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section

2014

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Background:Density of the drugs injected intrathecally is an important factor that influences spread in the cerebrospinal fluid. Mixing adjuvants with local anesthetics (LA) alters their density and hence their spread compared to when given sequentially in seperate syringes.Aims:To evaluate the efficacy of intrathecal administration of hyperbaric bupivacaine (HB) and clonidine as a mixture and sequentially in terms of block characteristics, hemodynamics, neonatal outcome, and postoperative pain.Setting and Design:Prospective randomized single blind study at a tertiary center from 2010 to 2012.Materials and Methods:Ninety full-term parturient scheduled for elective cesarean sections were divided into three groups on the basis of technique of intrathecal drug administration. Group M received mixture of 75 μg clonidine and 10 mg HB 0.5%. Group A received 75 μg clonidine after administration of 10 mg HB 0.5% through separate syringe. Group B received 75 μg clonidine before HB 0.5% (10 mg) through separate syringe.Statistical analysis used:Observational descriptive statistics, analysis of variance with Bonferroni multiple comparison post hoc test, and Chi-square test.Results:Time to achieve complete sensory and motor block was less in group A and B in which drugs were given sequentially. Duration of analgesia lasted longer in group B (474.3 ± 20.79 min) and group A (472.50 ± 22.11 min) than in group M (337 ± 18.22 min) with clinically insignificant influence on hemodynamic parameters and sedation.Conclusion:Sequential technique reduces time to achieve complete sensory and motor block, delays block regression, and significantly prolongs the duration of analgesia. However, it did not matter much whether clonidine was administered before or after HB.

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Vasopressors in obstetrics: what should we be using?

Abstract: When current evidence is considered, in the authors' opinion, phenylephrine is the vasopressor that most closely meets the criteria for the best vasopressor in obstetrics.

Cited by 117 publications

References 53 publications

Original research Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Original research Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

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

Efficacy of premixed versus sequential administration of clonidine as an adjuvant to hyperbaric bupivacaine intrathecally in cesarean section

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