Randomised double-blinded comparison of phenylephrine vs ephedrine for maintaining blood pressure during spinal anaesthesia for non-elective Caesarean section*

ObjectivesWe have previously established a method to measure transfer of nutrients between mother, placenta and fetus in vivo. The method includes measurements of maternal and fetal blood flow by Doppler ultrasound prior to spinal anaesthesia. Spinal anaesthesia affects maternal blood pressure and cardiac output. We aimed to determine the effect of spinal anaesthesia in mothers undergoing an elective caesarean section on blood pressure, heart rate and cardiac output, and whether cardiac output levels were comparable before induction of spinal anaesthesia and before delivery.DesignProspective cohort study.SettingTertiary hospital in Norway.Participants76 healthy women with uneventful pregnancies undergoing an elective caesarean section.InterventionsWe induced spinal anaesthesia with a standard prevention of hypotension including intravenous fluid coloading and phenylephrine infusion.Primary and secondary outcome measuresPrimary outcome measure was maternal cardiac output, and secondary outcome measures were invasive systolic blood pressure and heart rate. We measured heart rate and blood pressure by continuous invasive monitoring with a cannula in the radial artery. Cardiac output was estimated based on continuous arterial waveform. We compared maternal parameters 30 s before induction of spinal anaesthesia to 30 s before delivery.ResultsMedian age at delivery was 34.5 (range 21–43) years and 17 of 76 women were nulliparous. The most prevalent indications were previous caesarean section and maternal request. Among 76 included women, 71 had sufficient data for analysis of endpoints. Median cardiac output was 6.51 (IQR (5.56–7.54) L/min before spinal anaesthesia and 6.40 (5.83–7.56) L/min before delivery (p=0.40)). Median invasive systolic blood pressure increased from 128.5 (120.1–142.7) mm Hg to 134.1 (124.0–146.6) mm Hg (p=0.014), and mean heart rate decreased from 86.0 (SD 13.9) to 75.2 (14.2) (p<0.001).ConclusionsMaternal cardiac output at the time of caesarean delivery is comparable to levels before induction of spinal anaesthesia.Trial registration numberNCT00977769.

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A Comparative Study to Evaluate the Effect of Norepinephrine and Phenylephrine in the Treatment of Post Spinal Hypotension for Caesarean Section

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v8i1.8240 ◽

2022 ◽

Author(s):

Archita Patil ◽

Rashmee Chavan ◽

Shwetha K. Mudalagirigowda ◽

Sravya Adda

Keyword(s):

Caesarean Section ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Fluid Loading ◽

Time Intervals ◽

Induced Hypotension ◽

Cardiovascular Side Effects ◽

Blinded Study ◽

Spinal Hypotension ◽

Double Blinded

Background: Maternal hypotension due to spinal anaesthesia in caesarean section is commonly seen. Alongwith fluid loading, phenylephrine is used to manage the hypotension. However, this drug is associated with cardiovascular side effects. Methods: This is a prospective double blinded study which was conducted on 100 term parturients scheduled from elective caesarean section under spinal anaesthesia, randomly assigned into two groups. After spinal anaesthesia patients of group N and P were treated with norepinephrine (5mcg) and phenylephrine (50mcg) respectively as an IV bolus for hypotension. Blood pressure, heart rate, number of bolus doses given, and neonatal APGAR score was noted. Results: Patients of both groups were comparable with respect to haemodynamic parameters (HR, SBP, DBP, AND MAP). Incidence of bradycardia was higher in group P (22%, n=11) compared to group N (14%, n=7). Neonatal APGAR scores at different time intervals were similar in both groups. Conclusion: Intermittent boluses of norepinephrine were effective in the treatment of spinal anaesthesia induced hypotension during caesarean section and can be considered as an alternative to phenylephrine.

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COMPARISON OF VARIOUS PARAMETERS AFTER INDUCTION OF SPINAL ANAESTHESIA FOR CAESAREAN SECTION IN SITTING AND LATERAL POSITION

10.36106/ijsr/6737988 ◽

2021 ◽

pp. 22-24

Author(s):

Krishna Kumar ◽

Chandeshwar Choudhary ◽

Debarshi Jana

Keyword(s):

Blood Pressure ◽

Caesarean Section ◽

Pregnant Women ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Lateral Position ◽

Sitting Position ◽

Number Of Patients ◽

Position Group

Background: Hypotension is one of the common complications in patients undergoing surgeries under spinal anesthesia. This phenomenon is comparatively more in pregnant women undergoing caesarean section under spinal anesthesia due to anatomical variations in the spinal cord and physiological changes in pregnant women. Maternal position may inuence the spread of the local anaesthetic drug. So, in this study we have aimed to compare incidence of hypotension and various other parameters like onset of sensory and motor blockade, total number of mephentermine incremental doses (5mg/dose) required in each group to correct hypotension after induction of spinal anesthesia in sitting and lateral position for caesarean sections. Methods: Seventy American Society of Anesthesiologists physical status I and II patients undergoing elective caesarean section were randomnly divided into two groups by closed envelope technique to receive spinal anaesthesia in the lateral position (Group L) or the sitting position (Group S). In Lumbar (L3interspace, lumbar puncture was done after taking aseptic precautions, plain bupivacaine 0.5% heavy 10 or 12 mg according to the height was injected after conrming free ow of cerebro spinal uid. After this, they were placed in the supine position immediately with right wedge providing for left lateral uterine displacement to avoid supine hypotension syndrome. Maternal blood pressure was measured every minute for 5 minutes, every two min for 10 min and 5 minutely thereafter. Hypotension was dened as a fall in systolic blood pressure >20% of the baseline value or a value <90 mmHg. Results: Statistical studies showed that number of patients who received spinal anesthesia in lateral position had signicantly more incidences of hypotension (19 incidences) compared to those who received in sitting position ( 10 incidences) with P value being (P= 0.048). And also there was faster onset (average time) of action (sensory and motor) in Group L(5 minutes for sensory and 6.2 minutes for motor) than compared to Group S (7 minutes for sensory and 7.4 minutes for motor) but not statistically signicant ( P= 0.361 for sensory and 0.639 for motor). We also observed that, total number of incremental doses (5mg/dose) of mephentermine used were more in patients who received spinal anaesthesia in lateral position (n= 10 increments) than compared to those who received in sitting position( n=5 increments) but it was not statistically signicant (P=0.145). Conclusion: Spinal anesthesia given in lateral position of the patients for caesarean section causes signicantly more incidences of hypotension than that given in sitting position. And there were no signicant differences with respect to onset of sensory and motor block and mephentermine requirement between the groups.

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Effect of granisetron in attenuation of hypotension following spinal anaesthesia in parturients undergoing elective caesarean section - a double blind randomized controlled trial

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v3i1.14635 ◽

2016 ◽

Vol 3 (1) ◽

pp. 13-17

Author(s):

Suraj Lamichhane ◽

Siddhartha Koirala ◽

Satyendra Narayan Singh

Keyword(s):

Blood Pressure ◽

Caesarean Section ◽

Arterial Pressure ◽

Spinal Anaesthesia ◽

Elective Caesarean Section ◽

Saline Control ◽

Induced Hypotension ◽

Pre Treatment ◽

Type 3 ◽

Change In Mean

Background: Spinal anaesthesia has side effects like hypotension and bradycardia, which may be induced by sympathetic blockade and Bezold-Jarisch reflex (mediated by peripheral serotonin receptor, 5-HT3 type). The objective of the study was to evaluate the effects of type 3 serotonin receptors blockade by intravenous granisetron pre-treatment in spinal induced hypotension in parturient undergoing elective caesarean section.Methods: Fifty six parturient with American Society of Anaesthesiologists Physical Status I and II undergoing elective caesarean section were assigned randomly to receive either Normal Saline (control) or Granisetron 1mg intravenously five minutes before spinal anaesthesia. Spinal anaesthesia was performed with 2.2 ml 0.5% hyperbaric bupivacaine solution and then heart rates, systolic blood pressure, diastolic blood pressure, mean arterial pressure were recorded every two and half minutes for ten minutes and then every five minutes for till end of surgery after. Hemodynamic parameters were compared with baseline in each group.Results: Change in mean, systolic and diastolic arterial pressure compared with baseline value were comparable in both the groups, but use of ephedrine as rescue vasopressor drug was significantly reduced in granisetron group. The episodes of hypotension, nausea/vomiting and shivering were comparable in both groups.Conclusions: Type 3 serotonin blockade by intravenous granisetron pre-treatment does not reduce spinal induced hypotension in parturient undergoing elective caesarean section; however there is reduction in need of rescue vasopressor.

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