scholarly journals Comparison of efficacy and safety of preemptive infusion protocols of ephedrine and phenylephrine - prevention of hypotension and effects on hemodynamic parameters during spinal anesthesia for caesarean section

2020 ◽  
Vol 148 (3-4) ◽  
pp. 173-179
Author(s):  
Aleksandra Vukotic ◽  
David Green ◽  
Jasna Jevdjic ◽  
Milovan Vukotic ◽  
Nina Petrovic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Caesarean Section ◽  
Cesarean Section ◽  
Stroke Volume ◽  
Spinal Anesthesia ◽  
Hemodynamic Parameters ◽  
Efficacy And Safety ◽  
Non Invasive

Introduction/Objective. Spinal anesthesia (SA) for cesarean section may lead to significant changes in hemodynamic parameters, especially hypotension. The aim of this study was to determine and compare the efficacy and safety of preemptive infusion protocols of the two most commonly used vasopressors, ephedrine (Group E, n = 29) and phenylephrine (Group P, n = 31) not only on prevention of hypotension but also to determine their effect on hemodynamic parameters, such as stroke volume (SV) and cardiac output (CO) using a continuous non-invasive hemodynamic monitor. Methods. The infusion of ephedrine was administered at the rate of 5 mg/min. immediately after SA. Phenylephrine was administered at an infusion rate of 25 ?g/min for two minutes prior to SA. Results. In Group E, mean systolic blood pressure (SBP) and heart rate (HR) were similar to baseline. CO was higher (p < 0.001), while systemic vascular resistance (SVR) was lower than baseline (p < 0.001). In Group P, mean SBP and diastolic blood pressure (DBP) were lower than baseline, respectively (p = 0.006, p < 0.001). SBP, DBP, CO, SV, SVR, and HR were significantly different between the E and P groups (p < 0.001). Conclusion. E and P vasopressors are both effective in the prevention of hypotension during SA.

Treatment of Hypotension after Hyperbaric Tetracaine Spinal Anesthesia 

1997 ◽  
Vol 86 (4) ◽  
pp. 797-805 ◽  
Author(s):  
Robert F. Brooker ◽  
John F. IV Butterworth ◽  
Dalane W. Kitzman ◽  
Jeffrey M. Berman ◽  
Hillel I. Kashtan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Systolic Blood Pressure ◽  
Spinal Anesthesia ◽  
Adrenergic Agonist ◽  
Induced Hypotension ◽  
Alpha Adrenergic Agonist ◽  
Hyperbaric Tetracaine

Background Despite many advantages, spinal anesthesia often is followed by undesirable decreases in blood pressure, for which the ideal treatment remains controversial. Because spinal anesthesia-induced sympathectomy and management with a pure alpha-adrenergic agonist can separately lead to bradycardia, the authors hypothesized that epinephrine, a mixed alpha- and beta-adrenergic agonist, would more effectively restore arterial blood pressure and cardiac output after spinal anesthesia than phenylephrine, a pure alpha-adrenergic agonist. Methods Using a prospective, double-blind, randomized, cross-over study design, 13 patients received sequential infusions of epinephrine and phenylephrine to manage hypotension after hyperbaric tetracaine (10 mg) spinal anesthesia. Blood pressure, heart rate, and stroke volume (measured by Doppler echocardiography using the transmitral time-velocity integral) were recorded at baseline, 5 min after injection of tetracaine, and before and after management of hypotension with epinephrine and phenylephrine. Cardiac output was calculated by multiplying stroke volume x heart rate. Results Five min after placement of a hyperbaric tetracaine spinal anesthesia, significant decrease in systolic (from 143 +/- 6 mmHg to 125 +/- 5 mmHg; P &lt; 0.001), diastolic (from 81 +/- 3 to 71 +/- 3; P &lt; 0.001), and mean (from 102 +/- 4 to 89 +/- 3; P &lt; 0.001) arterial pressures occurred. Heart rate (75 +/- 4 beats/min to 76 +/- 4 beat/min; P = 0.9), stroke volume (115 +/- 17 to 113 +/- 13; P = 0.9), and cardiac output (8.0 +/- 1 l/m to 8.0 +/- 1l/m; P = 0.8) did not change significantly after spinal anesthesia. Phenylephrine was effective at restoring systolic blood pressure after spinal anesthesia (120 +/- 6 mmHg to 144 +/- 5 mmHg; P &lt; 0.001) but was associated with a decrease in heart rate from 80 +/- 5 beats/min to 60 +/- 4 beats/min (P &lt; 0.001) and in cardiac output from 8.6 +/- 0.7 l/m to 6.2 +/- 0.7 l/m (P &lt; 0.003). Epinephrine was effective at restoring systolic blood pressure after spinal anesthesia (119 +/- 5 mmHg to 139 +/- 6 mmHg; P &lt; 0.001) and was associated with an increase in stroke volume from 114 +/- 12 ml to 142 +/- 17 (P &lt; 0.001) and cardiac output from 7.8 +/- 0.6 l/m to 10.8 +/- 1.1 l/m (P &lt; 0.001). Conclusions Epinephrine management of tetracaine spinal-induced hypotension increases heart rate and cardiac output and restores systolic arterial pressure but does not restore mean and diastolic blood pressure. Phenylephrine management of tetracaine spinal-induced hypotension decreases heart rate and cardiac output while restoring systolic, mean, and diastolic blood pressure.

Analysis of the impact of a single artificial carbonic acid water bath on hemodynamic parameters in patients with hypertension

Physiotherapy ◽  
2014 ◽  
Vol 22 (4) ◽  
Author(s):  
Rafał Szafraniec ◽  
Wioletta Fryc ◽  
Maciej Kochański
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Carbonic Acid ◽  
Water Bath ◽  
Acid Water ◽  
Hemodynamic Parameters ◽  
Double Product ◽  
The Impact

AbstractAim of the study. The aim of this study was to investigate the effect of a single artificial carbonic acid water bath on hemodynamic parameters in patients with hypertension.Material and methods. Hypertensive patients (n = 33) were measured blood pressure and heart rate before the bath and during the last minute of treatment. Additionally calculated: stroke volume (SV), cardiac output (Q), double product (RPP). The mineral water used in the therapeutic bath was artificially enriched with carbon dioxide (1000 mg/dmResults. HR decreased by 7.6 bpm (p = 0.000001), systolic blood pressure by 9.2 mm Hg (p = 0.000001), diastolic blood pressure by 7.2 mm Hg (p = 0.000001), RPP by 1970.7 (p = 0.000001), SV increased by 3.3 ml (p = 0.00004), and Q did not change and in the both measurements was 3.7 l/min.Conclusions. During the single carbonic acid bath, a decrease in blood pressure, heart rate and double product was observed. Stroke volume has increased, while there was no effect on cardiac output.

Non-Invasive Monitoring of Hemodynamic Parameters during Hemodialysis

1995 ◽  
Vol 18 (9) ◽  
pp. 499-503 ◽  
Author(s):  
F. Pizzarelli ◽  
P. Dattolo ◽  
M. Piacenti ◽  
M.A. Morales ◽  
T. Cerrai ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Blood Volume ◽  
Impedance Cardiography ◽  
Hemodynamic Parameters ◽  
Non Invasive ◽  
Transthoracic Impedance ◽  
Cardiac Output Index ◽  
On Line ◽  
Two Parameters

We studied in 13 hemodialysis patients intradialytic variations of blood volume (BV) and cardiac output, by means of non-invasive methods. We found a weak correlation, r 0.2 or less, between BV variations and intradialysis blood pressure variations. The sensitivity of the former in describing the variations of the latter was only 32%. During the 30 min preceeding the hypotensive crisis the percent BV variations did not show any predictive trend. On the contrary, refilling increased as blood pressure dropped and a weak inverse relation (r -0.35) was found between these two parameters. Unstable patients had predialytic blood volume values significantly lower than stable ones and comparable to healthy subjects. On the contrary, the correlation between percent variations of cardiac output index and MAP was 0.68 with a sensitivity and specificity of 90% and 59%, respectively. Unfortunately these promising results were obtained only with an estimate of cardiac output obtained by echocardiography and not by transthoracic impedance cardiography, which is much more feasible than the former as on-line monitoring of cardiac output. On-line monitoring of hemodynamic parameters is an appealing but still unsolved task.

Effect of sympathetic blockade on diurnal variation of hemodynamic patterns

1989 ◽  
Vol 256 (3) ◽  
pp. R778-R785 ◽  
Author(s):  
M. I. Talan ◽  
B. T. Engel
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Total Peripheral Resistance ◽  
Peripheral Resistance ◽  
Base Line ◽  
Sympathetic Blockade ◽  
Selective Blockade ◽  
Arterial Blood

Heart rate, stroke volume, and intra-arterial blood pressure were monitored continuously in each of four monkeys, 18 consecutive h/day for several weeks. The mean heart rate, stroke volume, cardiac output, systolic and diastolic blood pressure, and total peripheral resistance were calculated for each minute and reduced to hourly means. After base-line data were collected for approximately 20 days, observation was continued for equal periods of time under conditions of alpha-sympathetic blockade, beta-sympathetic blockade, and double sympathetic blockade. This was achieved by intra-arterial infusion of prazosin, atenolol, or a combination of both in concentration sufficient for at least 75% reduction of response to injection of agonists. The results confirmed previous findings of a diurnal pattern characterized by a fall in cardiac output and a rise in total peripheral resistance throughout the night. This pattern was not eliminated by selective blockade, of alpha- or beta-sympathetic receptors or by double sympathetic blockade; in fact, it was exacerbated by sympathetic blockade, indicating that the sympathetic nervous system attenuates these events. Because these findings indicate that blood volume redistribution is probably not the mechanism mediating the observed effects, we have hypothesized that a diurnal loss in plasma volume may mediate the fall in cardiac output and that the rise in total peripheral resistance reflects a homeostatic regulation of arterial pressure.

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.

Leg crossing improves orthostatic tolerance in healthy subjects: a placebo-controlled crossover study

2006 ◽  
Vol 291 (4) ◽  
pp. H1768-H1772 ◽  
Author(s):  
C. T. Paul Krediet ◽  
Johannes J. van Lieshout ◽  
Lysander W. J. Bogert ◽  
Rogier V. Immink ◽  
Yu-Sok Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Output ◽  
Stroke Volume ◽  
Crossover Study ◽  
Healthy Subjects ◽  
Lower Body Negative Pressure ◽  
Vasovagal Syncope ◽  
Orthostatic Tolerance ◽  
Healthy Human

Vasovagal syncope is the most common cause of transient loss of consciousness, and recurrent vasovagal fainting has a profound impact on quality of life. Physical countermaneuvers are applied as a means of tertiary prevention but have so far only proven useful at the onset of a faint. This placebo-controlled crossover study tested the hypothesis that leg crossing increases orthostatic tolerance. Nine naïve healthy subjects [6 females, median age 25 yr (range 20–41 yr), mean body mass index 23 (SD 2)] were subjected to passive head-up tilt combined with a graded lower body negative pressure challenge (20, 40, and 60 mmHg) determining orthostatic tolerance thrice, in randomized order: 1) control, 2) with leg crossing, and 3) with oral placebo. Blood pressure (Finometer), heart rate, and changes in thoracic blood volume (impedance), stroke volume, and cardiac output (Modelflow) were followed during orthostatic stress. Primary outcome was time to presyncope (systolic blood pressure ≤85 mmHg, heart rate ≥140 beats/min). With leg crossing, orthostatic tolerance increased from 26 ± 2 to 34 ± 2 min (placebo 23 ± 3 min, P < 0.001). During leg crossing, mean arterial pressure (81 vs. 81 mmHg) and cardiac output (95 vs. 94% supine) remained unchanged; heart rate increase was lower (13 vs. 18 beats/min, P < 0.05); stroke volume was higher (79 vs. 74% supine, P < 0.05); and there was a trend toward lower thoracic impedance. Leg crossing increases orthostatic tolerance in healthy human subjects. As a measure of prevention, it is a worthwhile addition to the management of vasovagal syncope.

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.

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]

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