Fetal and Maternal Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery

2002 ◽  
Vol 97 (6) ◽  
pp. 1582-1590 ◽  
Author(s):  
David W. Cooper ◽  
Mark Carpenter ◽  
Paul Mowbray ◽  
William R. Desira ◽  
David M. Ryall ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Systolic Arterial Pressure ◽  
Nausea And Vomiting ◽  
Combination Group ◽  
Routine Practice ◽  
The Mean ◽  
Fetal Acidosis ◽  
Group 1

Background In our routine practice, we observed a reduced incidence of fetal acidosis (umbilical artery pH < 7.20) at cesarean delivery during spinal anesthesia when a combination of phenylephrine and ephedrine was used as first line vasopressor therapy, compared with using ephedrine alone. Methods The study was randomized and double blind. It compared phenylephrine 100 microg/ml (phenylephrine group), ephedrine 3 mg/ml (ephedrine group), and phenylephrine 50 microg/ml combined with ephedrine 1.5 mg/ml (combination group), given by infusion, to maintain maternal systolic arterial pressure at baseline during spinal anesthesia for elective cesarean delivery. Results Fetal acidosis was less frequent in the phenylephrine group (1 of 48) (P = 0.004) and less frequent in the combination group (1 of 47) (P = 0.005) than in the ephedrine group (10 of 48). The mean systolic arterial pressure was similar for the three groups: Phenylephrine group median 98% (IQR 94-103) of baseline, ephedrine group 100% (96-106) and combination group 101% (97-108) (P = 0.11). The mean heart rate was higher in the ephedrine group (median 107% [IQR 99-118] of baseline) than in the phenylephrine group (88% [82-98]) (P < 0.0001), or the combination group (96% [86-102]) (P < 0.0001). Nausea and vomiting were less frequent in the phenylephrine group (nausea 17%, vomiting 0%) than in the ephedrine group (nausea 66%, vomiting 36%) (P < 0.0001), or the combination group (nausea 55%, vomiting 18%) (P < 0.0001). Conclusions Giving phenylephrine alone by infusion at cesarean delivery was associated with a lower incidence of fetal acidosis and maternal nausea and vomiting than giving ephedrine alone. There was no advantage to combining phenylephrine and ephedrine because it increased nausea and vomiting, and it did not further improve fetal blood gas values, compared with giving phenylephrine alone.

scholarly journals Hemodynamic Changes Associated with Spinal Anesthesia for Cesarean Delivery in Severe Preeclampsia

2008 ◽  
Vol 108 (5) ◽  
pp. 802-811 ◽  
Author(s):  
Robert A. Dyer ◽  
Jenna L. Piercy ◽  
Anthony R. Reed ◽  
Carl J. Lombard ◽  
Leann K. Schoeman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Output ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Systemic Vascular Resistance ◽  
Vascular Resistance ◽  
Severe Preeclampsia

Background Hemodynamic responses to spinal anesthesia (SA) for cesarean delivery in patients with severe preeclampsia are poorly understood. This study used a beat-by-beat monitor of cardiac output (CO) to characterize the response to SA. The hypothesis was that CO would decrease from baseline values by less than 20%. Methods Fifteen patients with severe preeclampsia consented to an observational study. The monitor employed used pulse wave form analysis to estimate nominal stroke volume. Calibration was by lithium dilution. CO and systemic vascular resistance were derived from the measured stroke volume, heart rate, and mean arterial pressure. In addition, the hemodynamic effects of phenylephrine, the response to delivery and oxytocin, and hemodynamics during recovery from SA were recorded. Hemodynamic values were averaged for defined time intervals before, during, and after SA. Results Cardiac output remained stable from induction of SA until the time of request for analgesia. Mean arterial pressure and systemic vascular resistance decreased significantly from the time of adoption of the supine position until the end of surgery. After oxytocin administration, systemic vascular resistance decreased and heart rate and CO increased. Phenylephrine, 50 mug, increased mean arterial pressure to above target values and did not significantly change CO. At the time of recovery from SA, there were no clinically relevant changes from baseline hemodynamic values. Conclusions Spinal anesthesia in severe preeclampsia was associated with clinically insignificant changes in CO. Phenylephrine restored mean arterial pressure but did not increase maternal CO. Oxytocin caused transient marked hypotension, tachycardia, and increases in CO.

Evidence That Intravenous Vasopressors Can Affect Rostral Spread of Spinal Anesthesia in Pregnancy

2004 ◽  
Vol 101 (1) ◽  
pp. 28-33 ◽  
Author(s):  
David W. Cooper ◽  
Leo Jeyaraj ◽  
Ryan Hynd ◽  
Rebekah Thompson ◽  
Tim Meek ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Epidural Space ◽  
Systolic Arterial Pressure ◽  
Light Touch ◽  
Double Blind ◽  
Touch Sensation ◽  
Upper Level ◽  
Combined Spinal Epidural Anesthesia ◽  
In Pregnancy

Background The authors have previously observed an apparent association between rostral spread of spinal anesthesia and choice of intravenous vasopressor given to maintain maternal systolic arterial pressure during cesarean delivery. This study tested the hypothesis that an intravenous infusion of phenylephrine can reduce rostral spread of spinal anesthesia in pregnancy, compared with ephedrine. Methods The study was randomized and double blind. It compared phenylephrine 100 microg/ml (phenylephrine group, n = 30), and ephedrine 3 mg/ml (ephedrine group, n = 30), given by infusion, to prevent maternal hypotension during combined spinal-epidural anesthesia for cesarean delivery. Two ml intrathecal plain levobupivacaine, 0.5%, combined with 0.4 ml intrathecal fentanyl, 50 microg/ml, and 10 ml epidural saline was given with the patient in the sitting position. The upper level of neural blockade to cold and light touch sensation was recorded at 10 and 20 min postspinal. Epidural space pressure was recorded at 5, 10, 15, and 20 min. Results At 20 min, the upper dermatome blocked to cold sensation was median T3 (interquartile range, T2-T4) for the phenylephrine group, compared with T1 (T1-T2) for the ephedrine group (P = 0.001). At 20 min, the upper dermatome blocked to light touch sensation was median T5 (T4-T8) for the phenylephrine group, compared with T3 (T2-T6) for the ephedrine group (P = 0.009). The mean epidural space pressure in the phenylephrine group was 16 (13-19) mmHg, compared with 16 (13-18) mmHg in the ephedrine group (P = 0.63). Conclusions This study provides evidence that intravenous phenylephrine can decrease rostral spread of spinal anesthesia in pregnancy, compared with intravenous ephedrine. Further work is required to investigate possible mechanisms and to assess its clinical significance.

scholarly journals Predictors of hypotension during surgical management of femoral fractures in spinal anesthesia

2018 ◽  
Vol 71 (7-8) ◽  
pp. 235-240
Author(s):  
Milica Gojkovic ◽  
Arsen Uvelin ◽  
Milanka Tatic ◽  
Vladimir Vrsjakov ◽  
Dunja Mihajlovic ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Spinal Anesthesia ◽  
Beta Blockers ◽  
Preoperative Evaluation ◽  
Femoral Fractures ◽  
Binary Logistic Regression ◽  
The Elderly ◽  
Elderly Age ◽  
The Mean

Introduction. Femoral fractures are the most common cause of morbidity and mortality in the elderly. The aim of this study was to establish the predictors of hypotension in the elderly patients with femoral fractures during surgery in spinal anesthesia. Material and Methods. This retrospective study included 454 patients and investigated the relationship between hypotension and predictive factors for the development of hypotension using binary logistic regression. A paired sample T-test for dependent variables was used to compare the mean arterial pressure before and after the surgical procedure. Three mean arterial pressure values were compared between subjects receiving bupivacaine and subjects who received levobupivacaine: preoperative, the lowest value during the surgery, and the mean arterial pressure at the end of the surgery. Results. The age of the subjects ranged from 20 to 93 years (mean = 71.56; standard deviation = 13.26, median = 74). The mean arterial pressure values during the preoperative evaluation (103.2 ? 14.7) were higher than the last mean arterial pressure during surgery (84.8 ? 13.6) and these differences were statistically significant (p < 0.001). The group of subjects who received levobupivacaine presented with higher values of median arterial pressure (73.99) than the group receiving bupivacaine (70.76). Conclusion. The predictors of hypotension during surgery of patients with femoral fractures in spinal anesthesia are elderly age and preoperative use of beta blockers.

Performance of the Hypotension Prediction Index With Noninvasive Arterial Pressure Waveforms in Awake Cesarean Delivery Patients Under Spinal Anesthesia

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Luciano Frassanito ◽  
Chiara Sonnino ◽  
Alessandra Piersanti ◽  
Bruno Antonio Zanfini ◽  
Stefano Catarci ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Spinal Anesthesia ◽  
Cesarean Delivery

Change of Positional Blood Pressure and Indication of Ephedrine in Hypotension During Spinal Anesthesia for Cesarean Delivery

2013 ◽  
Vol 21 (Number 2) ◽  
pp. 18-23
Author(s):  
Md. A Matin ◽  
J Banu ◽  
K Sultana ◽  
S M Shahana
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Clinical Practice ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lateral Position ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
The Mean

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in clinical practice. Certain risk factors play a role in altering the incidence of hypotension. A cross sectional observational study was done on sixty patients undergone cesarean delivery spinal anesthesia in Holy Family Red Crescent Medical College Hospital to evaluate the correlation between pre-anesthetic change of positional blood pressure and predictive necessity of Ephedrine to mange per-operative hypotension. The mean age of the patients included in the study was 25.85 ± 4.24 years and weighted 63.60 ± 6.91 kg (Mean ± sco. The haemodynamic outcomes of the patients are summarized in Table-I as mean systolic blood pressure increased (118 ± 12.02 and 132 ± 14.11 mm of Hg) after change of position from baseline (supine position) to right lateral position. The positional blood pressure varied from 2 to 32 mm of Hg and was observed in 54 patients. But only 35 patients were hypotensive (58.33%) after spinal anesthesia among them only 28 patients required Ephedrine (46.6%). But there was no significant correlation was observed in patients needed Ephedrine who hypotension but not obvious with positional change of pre-anesthetic blood pressure.

Sign in / Sign up

Export Citation Format

Share Document