Norepinephrine versus Ephedrine Boluses To Treat Spinal-Induced Hypotension in Cesarean Deliveries

Abstract Corresponding Background Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported to occur in up to 80% of spinal anesthesia cases. When maternal hypotension associated with spinal anesthesia for cesarean section is severe and sustained, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow with consecutive fetal hypoxia, acidosis, and neurological injury. Aim of the Work to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to counterbalance the hypotensive effect of spinal anesthesia during cesarean delivery. The results of the study showed that compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in norepinephrine compared with the use of ephedrine. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

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Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia

QJM ◽

10.1093/qjmed/hcab086.068 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed I Shahin ◽

Ayman M Kamaly ◽

Mohamed Saleh ◽

Ashraf E El-Agamy

Keyword(s):

Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Hypotensive Effect ◽

Maternal Blood ◽

Cesarean Sections ◽

Fluid Loading ◽

Elective Cesarean ◽

Spinal Hypotension ◽

Maternal Blood Pressure

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Patients and Methods 120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

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Norepinephrine versus ephedrine for hypotension prophylaxis during cesarean section under spinal anesthesia

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00124-4 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Ashraf E. Elagamy ◽

Aiman M. Kamaly ◽

Mohamed I. Shahin ◽

Mohamed Saleh

Keyword(s):

Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Hypotensive Effect ◽

Maternal Blood ◽

Anesthetic Technique ◽

Double Blind Study ◽

Double Blind ◽

Spinal Hypotension ◽

Maternal Blood Pressure

Abstract Background Spinal anesthesia is the preferred anesthetic method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been tried to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. The aim of this prospective, randomized, double blind study is to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Methods In the present study, 120 pregnant female undergoing elective CS were randomly divided into “group E” for ephedrine and “group N” for norepinephrine, 60 female in each group. Standard spinal anesthetic technique using 25 spinal needle under complete aseptic technique with injection of 1.8–2.2 ml of heavy bupivacaine 0.5% plus 25 μg of fentanyl according to female height. Group E will receive 10 mg of i.v. diluted ephedrine as hypotension prophylaxis, and group N will receive 16 μg as hypotension prophylaxis at the time of intrathecal block. Measurements of intraoperative episodes of hypotension and their treatment with the same dose of the studied drug in each group, incidence of intraoperative nausea and vomiting, and APGAR score of baby at 1 and 5 min will be recorded. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure. Further, it was associated with lower numbers of hypotension episodes, but more frequency of bradycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

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The effect of isosorbide dinitrate on placental blood flow and maternal blood pressure in women with pregnancy induced hypertension

American Journal of Hypertension ◽

10.1016/s0895-7061(98)00249-0 ◽

1999 ◽

Vol 12 (4) ◽

pp. 341-347 ◽

Cited By ~ 24

Author(s):

I Thaler

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Isosorbide Dinitrate ◽

Maternal Blood ◽

Pregnancy Induced Hypertension ◽

Induced Hypertension ◽

Placental Blood ◽

Placental Blood Flow ◽

Maternal Blood Pressure

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Responses of fetal sheep to simulated no-decompression dives

Journal of Applied Physiology ◽

10.1152/jappl.1980.48.5.776 ◽

1980 ◽

Vol 48 (5) ◽

pp. 776-780 ◽

Cited By ~ 11

Author(s):

M. K. Stock ◽

E. H. Lanphier ◽

D. F. Anderson ◽

L. C. Anderson ◽

T. M. Phernetton ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Maternal Blood ◽

Arterial System ◽

Fetal Sheep ◽

Monitoring Result ◽

Placental Blood ◽

Near Term ◽

Placental Blood Flow ◽

Maternal Blood Pressure

The effect of simulated standard no-decompression dives to 60 and 100 ft of seawater was tested in 12 near term sheep carrying 16 fetuses. In the immediate postdive period there were no significant changes in fetal blood pressure or fetal placental or renal blood flow, but the maternal blood pressure was elevated and the maternal placental blood flow was depressed. Six surgically prepared fetuses were dived to 100 ft. Five died within 20 min of ascent and the sixth suffered severe cardiac arrhythmia and hypotension. At autopsy all fetuses were observed to have massive bubbling in the arterial system and heart. Five fetuses were dived to 100 ft without surgery. Two were alive 3 h later and no bubbles were present at autopsy, and three were born alive at term. With the 60-ft dives, three fetuses were subjected to surgery and all suffered massive bubbling. Two fetuses were dived to 60 ft without surgery; one was alive after 3 h and the other was born alive at term. We conclude that surgery and monitoring result in the formation of postdive gas bubbles that would not otherwise appear.

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Anesthesia for Cesarean Delivery: Effects on the Fetus of Maternal Blood Pressure Control

Anesthesia and the Fetus ◽

10.1002/9781118477076.ch25 ◽

2012 ◽

pp. 235-243

Author(s):

Warwick D. Ngan Kee

Keyword(s):

Blood Pressure ◽

Cesarean Delivery ◽

Blood Pressure Control ◽

Pressure Control ◽

Maternal Blood ◽

Maternal Blood Pressure

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Effect of transdermal nitroglycerin patch on severe preeclamptic women with abnormal Doppler indices

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190291 ◽

2019 ◽

Vol 8 (2) ◽

pp. 597

Author(s):

El-Sayed S. El-Ebshehy ◽

Ahmed M. Hagras ◽

Amr T. Elbadry ◽

Ahmed M. Awara

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Maternal Blood ◽

Placental Insufficiency ◽

University Hospitals ◽

Singleton Pregnancy ◽

Arterial Blood ◽

Risk Pregnancy ◽

Doppler Indices ◽

Maternal Blood Pressure

Background: The aim is to evaluate the effect of maternal transdermal nitro-glycerine patch administration on blood flow resistance on maternal uterine artery, fetal umbilical and middle cerebral arteries in patients with severe pre-eclampsia in early gestational age (24 weeks to 33 weeks) associated with abnormal Doppler indices (placental insufficiency) and also its effect on maternal mean arterial blood pressure.Methods: This is a prospective interventional clinical trial conducted on (50) pregnant women with singleton pregnancy diagnosed with severe pre-eclampsia admitted in high-risk pregnancy unit at the Department of Obstetrics in Tanta University Hospitals, A 50-mg transdermal GTN patch (Novartis Pharma) was applied to the abdominal skin, releasing nitroglycerin at a rate of 0.4 mg/h. Doppler ultrasonography and measurement of maternal blood pressure were performed before application of transdermal GTN patch, after 4 hours of application, after 24 hours and after 48 hours.Results: the application of a 50-mg transdermal GTN patch to the maternal abdomen was associated with a significant decline in the PI of the uteroplacental and fetoplacental blood flow. No change was observed in the PI of the cerebral circulation. And also, there was a significant decrease in maternal blood pressure (MAP).Conclusions: Nitroderm patch (nitric oxide donors) may be used as initial therapy in cases of severe preeclampsia complicated by placental insufficiency in the form of abnormal Doppler indices.

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