Prophylactic Angiotensin II Infusion during Spinal Anesthesia for Elective Cesarean Delivery 

1998 ◽  
Vol 88 (6) ◽  
pp. 1475-1479 ◽  
Author(s):  
Robert D. Vincent ◽  
Carol F. Werhan ◽  
Patricia F. Norman ◽  
Grace H. Shih ◽  
David H. Chestnut ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Angiotensin Ii ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Elective Cesarean Delivery ◽  
Maternal Heart Rate ◽  
Elective Cesarean

Background Angiotensin II may prove useful in treating regional anesthesia-induced hypotension in obstetric patients, because it causes less uterine vasoconstriction than do other vasoconstrictor drugs (such as phenylephrine). This study compared (1) maternal blood pressure and heart rate and (2) fetal status at delivery in parturients given either prophylactic angiotensin II or ephedrine infusion during spinal anesthesia for elective cesarean delivery. Methods Fifty-four women were randomized to receive either angiotensin II or ephedrine infusion intravenously during spinal anesthesia for elective cesarean section delivery. Simultaneous with subarachnoid injection, infusion of angiotensin II (2.5 microg/ml) or ephedrine (5 mg/ml) was initiated at 10 ng x kg(-1) x min(-1) and 50 microg x kg(-1) x min(-1), respectively. The rate of each infusion was adjusted to maintain maternal systolic blood pressure at 90-100% of baseline. Results Cumulative vasopressor doses (mean+/-SD) through 10, 20, and 30 min were 150+/-100, 310+/-180, and 500+/-320 ng/kg in the angiotensin group and 480+/-210, 660+/-390, and 790+/-640 microg/kg in the ephedrine group. Maternal heart rate was significantly higher (P < 0.001) during vasopressor infusion in the ephedrine group than in the angiotensin group. Umbilical arterial and venous blood pH and base excess were all significantly higher (P < 0.05) in the angiotensin group than in the ephedrine group. Conclusions Angiotensin II infusion maintained maternal systolic blood pressure during spinal anesthesia without increasing maternal heart rate or causing fetal acidosis.

Phenylephrine Added to Prophylactic Ephedrine Infusion during Spinal Anesthesia for Elective Cesarean Section

2001 ◽  
Vol 95 (3) ◽  
pp. 668-674 ◽  
Author(s):  
Frédéric J. Mercier ◽  
Edward T. Riley ◽  
Willard L. Frederickson ◽  
Sandrine Roger-Christoph ◽  
Dan Benhamou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Elective Cesarean ◽  
American Society ◽  
Spinal Hypotension

Background Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy. Methods Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses. Results Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups. Conclusion Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.

scholarly journals Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

2017 ◽  
Vol 3 (4) ◽  
pp. 95-101
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Central Venous Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Venous Pressure ◽  
Elective Cesarean Delivery ◽  
Central Venous ◽  
Arterial Blood ◽  
Elective Cesarean

ABSTRACT Introduction Spinal anesthesia is widely used in the management of uncomplicated cesarean section. Maternal hypotension is the commonest serious problem which decreases uterine blood flow causing fetal hypoxia, acidosis, and neonatal depression. Fluid administration before start of the surgery (preloading) with crystalloid is found to be ineffective due to rapid redistribution of fluids in various tissue spaces. A “coload” given at the time of spinal anesthesia may be more effective. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used central venous pressure (CVP) measurement technique in parturients receiving rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in volume and therefore reduce vasopressor requirements. Materials and methods We recruited healthy term women scheduled for elective cesarean delivery under spinal anesthesia for this randomized study. Baseline heart rate, baseline mean arterial blood pressure (MAP), and CVP were recorded. At the time of spinal injection, subjects were allocated to receive a rapid 1 L coload of either polymerized gelatin 3.5% (Haemaccel) or Hartmann (crystalloid) solution. The primary outcome CVP was compared between groups, as were secondary outcomes: phenylephrine dose and maternal hemodynamics data. Results Maternal demographics, surgical times, and American Society of Anesthesiologists (ASA) were similar between groups. Baseline parameters were similar in all the three groups. Heart rate increased from the baseline in all the three groups; however, mean heart rate was highest in crystalloid group. Mean arterial blood pressure decreased in all the three groups from baseline; however, highest fall was recorded in crystalloid group. The incidence of hypotension was 66.66% in crystalloid group as compared with 36.66% in colloid group. Crystalloid group patients received 6.33 ± 4.54 mg of ephedrine as compared with 2.40 ± 2.82 mg in colloid group. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in crystalloid group as compared with colloid group. We found statistically significant differences in the mean preoperative CVP reading (p < 0.05) between the two groups, the mean CVP reading in crystalloid group being slightly lower. With preloading, similar CVP readings were obtained in both groups. The fall in CVP during subarachnoid blockade was also not significant. The CVP began to fall with the establishment of the block until the delivery of the baby after which it was found to rise. The predelivery CVP was significantly lower than preoperative CVP in both groups—the fall being significantly more in crystalloid group. Conclusion In our study, the results showed statistically significant decrease in volume requirement, when colloid coload is used than crystalloid coload using CVP monitor as a guide. Colloid coloading is effective and superior to crystalloid coloading for prevention of maternal hypotension in cesarean section. How to cite this article Sivanna U. Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure. J Med Sci 2017;3(4):95-101.

Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

2015 ◽  
Vol 122 (4) ◽  
pp. 736-745 ◽  
Author(s):  
Warwick D. Ngan Kee ◽  
Shara W. Y. Lee ◽  
Floria F. Ng ◽  
Perpetua E. Tan ◽  
Kim S. Khaw
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Adrenergic Receptor ◽  
Neonatal Outcome ◽  
Computer Controlled ◽  
Double Blinded

Abstract Background: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. Methods: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. Results: Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. Conclusions: When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.

Prophylactic Angiotensin II Infusion During Spinal Anesthesia for Elective Cesarean Delivery

1999 ◽  
Vol 43 (3) ◽  
pp. 146
Author(s):  
ROBERT D. VINCENT ◽  
CAROL F. WERHAN ◽  
PATRICIA F. NORMAN ◽  
GRACE H. SHIH ◽  
DAVID H. CHESTNUT ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Elective Cesarean Delivery ◽  
Elective Cesarean

scholarly journals Efficacy of Intravenous Ondansetron on Hemodynamic Complications in Women Undergoing Spinal Anesthesia for Cesarean Section: A Randomized Placebo Controlled Clinical Trial

2016 ◽  
Vol 5 (1) ◽  
pp. 13-18
Author(s):  
Pouran Hajian ◽  
Bita Malekianzadeh ◽  
Maryam Davoudi
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Placebo Group ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Controlled Clinical Trial ◽  
Sterile Water ◽  
Elective Cesarean

Background: Several methods are used for the prevention or decreasing the incidence of spinal anesthesia hemodynamic complications. Ondansetron is a 5HT3 receptor antagonist with known efficacy on preventing nausea and vomiting and probably on intrathecal opioid-induced pruritus. The present study aims to evaluate the effects of intravenous Ondansetron on the attenuation of blood pressure and heart rate, by 5HT3 blocking in vagal nerve endings and effect on Bezold Jarish reflex. Material and Methods: One hundred and two candidates for elective cesarean section were randomized into 2 groups of 51 cases, the Ondansetron group received 4mg Ondansetron intravenously before performing spinal anesthesia, and placebo group received 2cc sterile water. Hypotension was defined: Systolic blood pressure less than 100 MmHg or fall more than 20% from primary BP which was treated by administration of Ephedrine in case of any. In both groups, Ondansetron effect was studied on hypotension occurrence, bradycardia, consumed Ephedrine amount, pruritus, nausea and vomiting. Results: There were no statistically significant differences in systolic/diastolic blood pressure, Mean Arterial Pressure, heart rate and pruritus in both groups (P=0.081).Nausea and vomiting in the first 10 minutes after spinal anesthesia were lesser in Ondansetron group (P= 0.001). Mean consumed Ephedrine was significantly lesser in Ondansetron group (5.8 mg in Ondansetron and 10.7 mg in placebo group, P=0.009). Conclusion: Ondansetron  given  intravenously  with  antiemetic  dose  (4  mg)  decreases  mean consumed Ephedrine and nausea and vomiting after spinal anesthesia, but does not have an influence on blood pressure, heart rate and pruritus.[GMJ. 2016;5(1):13-18]

scholarly journals Low Dose Hyperbaric Bupivacaine with Fentanyl in Spinal Anesthesia in Elective Cesarean Section

2019 ◽  
Vol 9 (2) ◽  
pp. 79-82
Author(s):  
Bharati Devi Sharma Regmi ◽  
Gopendra Prasad Deo ◽  
Subin Shrestha ◽  
Sabita Shrestha ◽  
Renuka Tamrakar Mishra
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Low Dose ◽  
Nausea And Vomiting ◽  
Elective Cesarean Section ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Elective Cesarean

Background: Spinal anesthesia with hyperbaric bupivacaine provides a dense neural block in cesarean delivery but associated with side effects like hypotension, bradycardia nausea and vomiting. Addition of low dose fentanyl with low dose of hyperbaric bupivacaine may decrease the in­cidence of these complications. The aims of study was to compare the hemodynamic parameters (blood pressure and heart rate), nausea and vomiting with low dose intrathecal hyperbaric bupivacaine with fentanyl vs a conventional dose of intrathecal hyperbaric bupivacaine in patient undergoing elective cesarean section. Methods: Seventy-four pregnant women aged 20-35 years old which un­derwent elective cesarean section at Chitwan Medical College were ran­domized into two groups. One group received spinal anesthesia with 8mg of0.5% hyperbaric bupivacaine and 25μg fentanyl and another group re­ceived 12mg 0.5% bupivacaine. Results: The mean age, baseline heart rate, systolic and diastolic blood pressure were comparable in both groups. Significant difference in hypo­tension (24.31% vs. 62.16%, p<0.05) and Nausea and vomiting (16.20% vs. 27%, p<0.05) were found in bupivacaine-fentanyl group versus a conven­tional dose of spinal bupivacaine group. Conclusions: Low dose of bupivacaine with Fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomit­ing in comparison to bupivacaine alone.

Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status

2017 ◽  
Vol 127 (2) ◽  
pp. 241-249 ◽  
Author(s):  
Allison J. Lee ◽  
Ruth Landau ◽  
James L. Mattingly ◽  
Margaret M. Meenan ◽  
Beatriz Corradini ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Umbilical Artery ◽  
Base Excess ◽  
Elective Cesarean Delivery ◽  
Acid Base ◽  
Elective Cesarean ◽  
Acid Base Status ◽  
Phenylephrine Infusion

Abstract Background Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining baseline systolic blood pressure, there would be no effect of maternal position on neonatal acid base status in women undergoing elective cesarean delivery with spinal anesthesia. Methods Healthy women undergoing elective cesarean delivery were randomized (nonblinded) to supine horizontal (supine, n = 50) or 15° left tilt of the surgical table (tilt, n = 50) after spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 15 μg, preservative-free morphine 150 μg). Lactated Ringer’s 10 ml/kg and a phenylephrine infusion titrated to 100% baseline systolic blood pressure were initiated with intrathecal injection. The primary outcome was umbilical artery base excess. Results There were no differences in umbilical artery base excess or pH between groups. The mean umbilical artery base excess (± SD) was −0.5 mM (± 1.6) in the supine group (n = 50) versus −0.6 mM (± 1.5) in the tilt group (n = 47) (P = 0.64). During 15 min after spinal anesthesia, mean phenylephrine requirement was greater (P = 0.002), and mean cardiac output was lower (P = 0.014) in the supine group. Conclusions Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid–base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status.

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