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

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.

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

QJM ◽  
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.

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

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed M Abo Kamar ◽  
Manal M Shams ◽  
Mai M AbdelAziz ◽  
Wessam Z Selima
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Hypotensive Effect ◽  
Maternal Blood ◽  
Neurological Injury ◽  
Maternal Complications ◽  
Placental Blood ◽  
Maternal Blood Pressure

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.

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 EPHEDRINE FOR PREVENTION HYPOTENSION

2007 ◽  
Vol 14 (04) ◽  
pp. 610-615 ◽  
Author(s):  
ABDUL-HAMEED CHOHEDRI ◽  
SHAHRBANO SHAHBAZI ◽  
L KHOJESTE ◽  
Elahe Alahyari
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Maternal Blood ◽  
Double Blind Study ◽  
Double Blind ◽  
Prophylactic Dose ◽  
Anesthesia Group ◽  
Group A ◽  
Study Setting ◽  
Maternal Blood Pressure

Background/Aim:. To ameliorate post spinal anesthesia hypotensionin patients undergoing cesarean section. To compare the incidence of maternal hypotension associated withspinal anesthesia for cesarean section when intravenous (IV), intramuscular (IM) or oral prophylactic boluses ofephedrine were used. Design: Prospective randomized double blind study. Setting: Department of anesthesiology,Zainibiae Hospital, Shiraz University, Iran. Period: From: June 2004 to November 2005. Materials and Methods:60 ASA grade I-II pregnant mothers were enrolled. Spinal anesthesia was performed using 60-70 mg of 5% solutionof lidocaine. The patients were divided into three equal groups (n=20). Oral and IM ephedrine (25 mg) wasadministered to the first two groups 30 to 60 minutes before induction of anesthesia (Group A and B, respectively). Inthe last 20 patients, IV Ephedrine (25 mg) was administered immediately after induction of spinal anesthesia (GroupC). Maternal blood pressure and pulse rate was checked every 2 minutes. Hypotension was promptly treated with 10-mg ephedrine boluses. Results: Both IM and IV prophylactic doses of ephedrine significantly decreased the incidenceof hypotension, compared to oral prophylactic dose of ephedrine [4/20 and 0/20 in the IM and IV ephedrine groups,respectively vs. 9/20 in the oral ephedrine group (p < 0.05)]. Conclusion: Oral prophylactic dose of ephedrine is noteffective in preventing hypotension in pregnant women undergoing cesarean section with spinal anesthesia. Therefore,we only recommend a single bolus of IV ephedrine with a dose of 25mg.

Effect of Epidural Epinephrine on the Minimum Local Analgesic Concentration of Epidural Bupivacaine in Labor

2002 ◽  
Vol 96 (5) ◽  
pp. 1123-1128 ◽  
Author(s):  
Linda S. Polley ◽  
Malachy O. Columb ◽  
Norah N. Naughton ◽  
Deborah S. Wagner ◽  
Cosmas J. M. van de Ven
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Confidence Interval ◽  
Epidural Analgesia ◽  
Fetal Heart Rate ◽  
Fetal Heart ◽  
Maternal Blood ◽  
Double Blind ◽  
Clinically Significant ◽  
Maternal Blood Pressure

Background The minimum local analgesic concentration (MLAC) has been defined as the median effective local analgesic concentration in a 20-ml volume for epidural analgesia in the first stage of labor. The aim of this study was to determine the local anesthetic-sparing efficacy of epidural epinephrine by its effect on the MLAC of bupivacaine. Methods In this double-blind, randomized, prospective study, 70 parturients who were at 7 cm or less cervical dilation and who requested epidural analgesia were allocated to one of two groups. After lumbar epidural catheter placement, 20 ml bupivacaine (n = 35) or bupivacaine with epinephrine 1:300,000 (n = 35) was administered. The concentration of bupivacaine was determined by the response of the previous patient in that group to a higher or lower concentration using up-down sequential allocation. Analgesic efficacy was assessed using 100-mm visual analog pain scores, with 10 mm or less within 30 min defined as effective. Results The MLAC of bupivacaine alone was 0.091% wt/vol (95% confidence interval, 0.081-0.102). The addition of epinephrine 1:300,000 (66.7 microg) resulted in a significant reduction (P &lt; 0.01) in the MLAC of bupivacaine to 0.065% wt/vol (95% confidence interval, 0.047-0.083). The lowest maternal blood pressure was significantly lower in the bupivacaine-epinephrine group (P = 0.03). There were statistically significant reductions in fetal heart rate (P = 0.011) in the bupivacaine-epinephrine group that were not clinically significant. Conclusions The addition of epidural epinephrine 1:300,000 (66 microg) resulted in a significant 29% reduction in the MLAC of bupivacaine. Coincident reductions in fetal heart rate and maternal blood pressure were also observed that were not clinically significant.

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