Phenylephrine Infusion Versus Bolus Regimens During Cesarean Delivery Under Spinal Anesthesia

Doherty, Anne Marie; Ohashi, Yayoi; Downey, Kristi; Carvalho, Jose C. A.

doi:10.1213/ane.0b013e31826ac3db

Cited by 99 publications

(65 citation statements)

References 24 publications

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“…6,17,28 However, it is known that continuous infusion of vasopressors is associated with higher doses in order to maintain blood pressure close to baseline values. 29 The vasopressor of choice with better profile for hemodynamic control of pregnant women in cesarean sections is still largely debatable, by the observation that during the anesthetic block installation there is a reduction in systemic vascular resistance, associated with increased cardiac output, which is mediated by increased heart rate. Thus, bradycardia caused by the administration of ␣-agonists results in decreased maternal cardiac output, leading some anesthesiologists to base their choice on the mother's heart rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

Aragão

Martíns

et al. 2014

Brazilian Journal of Anesthesiology (English Edition)

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Maternal hypotension is a common complication after spinal anesthesia for cesarean section, with deleterious effects on the fetus and mother. Among the strategies aimed at minimizing the effects of hypotension, vasopressor administration is the most efficient. The aim of this study was to compare the efficacy of phenylephrine, metaraminol, and ephedrine in the prevention and treatment of hypotension after spinal anesthesia for cesarean section. Ninety pregnant women, not in labor, undergoing cesarean section were randomized into three groups to receive a bolus followed by continuous infusion of vasopressor as follows: phenylephrine group (50 g + 50 g/min); metaraminol group (0.25 mg + 0.25 mg/min); ephedrine group (4 mg + 4 mg/min). Infusion dose was doubled when systolic blood pressure decreased to 80% of baseline and a bolus was given when systolic blood pressure decreased below 80%. The infusion dose was divided in half when systolic blood pressure increased to 120% and was stopped when it became higher. The incidence of hypotension, nausea and vomiting, reactive hypertension, bradycardia, tachycardia, Apgar scores, and arterial cord blood gases were assessed at the 1st and 5th minutes.There was no difference in the incidence of hypotension, bradycardia, reactive hypertension, infusion discontinuation, atropine administration or Apgar scores. Rescue boluses were higher only in the ephedrine group compared to metaraminol group. The incidence of nausea and vomiting and fetal acidosis were greater in the ephedrine group. The three drugs were effective in preventing hypotension; however, fetal effects were more frequent in the ephedrine group, although transient. Avaliação comparativa entre metaraminol, fenilefrina e efedrina na profilaxia e no tratamento da hipotensão em cesarianas sob raquianestesiaResumo Hipotensão materna é uma complicação comum após raquianestesia em cirurgia cesariana, trazendo efeitos deletérios para o feto e a mãe. Entre as estratégias com o objetivo de minimizar os efeitos da hipotensão, a administração de vasopressores é a mais eficiente. O objetivo deste estudo foi comparar a eficácia da fenilefrina, metaraminol e efedrina na prevenção e tratamento de hipotensão após raquianestesia em cirurgia cesariana. Noventa gestantes que não estavam em trabalho de parto submetidas à cesariana eletiva foram randomizadas em três grupos para receber um bolus, seguido de infusão contínua de vasopressor da seguinte forma: Grupo Fenilefrina (50 g + 50 g/min); Grupo Metaraminol (0,25 mg + 0,25 mg/min); Grupo Efedrina (4 mg + 4 mg/min). A dose da infusão foi dobrada quando a pressão arterial sistólica (PAS) decresceu até 80% dos valores basais e um bolus foi dado quando a PAS decresceu para valores abaixo de 80%. A dose da infusão foi dividida ao meio quando a PAS aumentou até 120% e foi interrompida quando mais elevada. Foram analisadas as incidências de hipotensão, náuseas e vômitos, hipertensão reativa, bradicardia, taquicardia e escores de Apgar no primeiro e quinto minutos e gases de sangue arterial d...

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Section: Discussionmentioning

confidence: 99%

Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

Aragão

Martíns

et al. 2014

Brazilian Journal of Anesthesiology (English Edition)

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“…In this study, systolic blood pressure in the ephedrine group (10 mg) was higher than the phenylephrine group (100 µg) and diastolic pressure in the phenylephrine 6 Iran Red Crescent Med J. 2017; 19(10):e13978.…”

Section: Discussionmentioning

confidence: 50%

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

Vakili¹,

Enayati²,

Dashipour³

2017

Iran Red Crescent Med J

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“…In the area of the management of spinal hypotension, Doherty et al [26] compared phenylephrine infusion (120 mg/min) to boluses of 120 mg phenylephrine to maintain SBP at baseline values. They measured CO using the NICOM monitor.…”

Section: Healthy Pregnant Womenmentioning

confidence: 99%

The role of cardiac output monitoring in obstetric anesthesia

Langesæter

Gibbs

Dyer

2015

Current Opinion in Anaesthesiology

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In healthy women, left lateral tilt remains an important clinical intervention during caesarean delivery, and phenylephrine is an essential early adjunct to fluid therapy. Noradrenaline may have a clinical benefit in selected patients. Carbetocin has similar haemodynamic effects to oxytocin. Haemodynamic changes associated with delivery per se may be minor compared with those due to oxytocin. Uncomplicated severe preeclampsia is usually associated with a normal to raised CO. Early-onset preeclampsia may be associated with more vasoconstriction and lower CO than late-onset disease. Passive leg raising may be useful to judge fluid responsiveness, and lung ultrasound may predict pulmonary oedema in preeclampsia. Further research is warranted to study the area of circulatory changes during delivery and the postpartum period, in healthy and preeclamptic women.

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Phenylephrine Infusion Versus Bolus Regimens During Cesarean Delivery Under Spinal Anesthesia

Cited by 99 publications

References 24 publications

Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia

Comparing Intravenous Phenylephrine and Ephedrine for Hypotension During Spinal Anesthesia for Elective Cesarean Section: A Randomized Double-Blind Clinical Trial

The role of cardiac output monitoring in obstetric anesthesia

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