Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study

Jaitawat, Sawai Singh; Partani, Seema; Sharma, Venus; Johri, Karishma; Gupta, Sunanda

doi:10.4103/joacc.joacc_20_19

Cited by 4 publications

(8 citation statements)

References 26 publications

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“…About 1397 duplicate literatures were deleted, 1656 literatures on subjects and interventions were deleted by reading title and abstract because they did not fit the inclusion criteria of this study, and 72 full texts that might meet the conditions were obtained. Subsequently, 5 research subjects did not conform to the criteria, and 50 intervention measures did not suit the criteria, 17 studies 8,10,15,16,[20][21][22][23][24][25][26][27][28][29][30][31][32] were finally included. Figure 1 was the flow chart for literature search and study selection.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Figure 1 was the flow chart for literature search and study selection. Of these 17 eligible studies, 10 were compared with the placebo (saline) 8,10,15,16,[25][26][27][28]30,31 ; 12 had two arms [20][21][22][23][24][25][26][27][29][30][31][32] ; 3 had three arms 8,10,15 ; 2 had four arms. 16,28 The characteristics of the selected included studies were displayed in Table 1, and the network plot and rank histogram were presented in Figure 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Our primary outcome was that 16 studies (1513 patients) reported the incidence of hypotension. 8,10,15,16,[20][21][22][23][24][25][26][27][28][29][30][31] The pairwise meta-analysis showed that compared with placebo (saline), prophylactic bolus injection of EP (high) (OR 14.66, 95% CI 4.22 to 50.91), EP (low) (OR 1.91, 95% CI 1.01 to 3.58), EP (middle) (OR 4.17, 95% CI 1.35…”

Section: Incidence Of Maternal Hypotensionmentioning

confidence: 99%

“…Data on maternal bradycardia were collected in 13 trials (1234 patients). 10,15,20,[22][23][24][25][26][27][28][29][30]32 The pair-wise meta-analysis indicated that no difference was detected between active intervention and placebo (saline) (Figure S3). The results of NMA showed in Table 4.…”

Section: Maternal Bradycardiamentioning

confidence: 99%

“…Fifteen studies (1394 patients) reported the incidence of intraoperative nausea or vomiting (IONV). 8,10,15,16,[20][21][22][24][25][26][27][28][29][30]32 The pair-wise metaanalysis indicated that no difference was detected between interventions (Figure S4). The results of NMA suggested that there was no different among interventions (Table 5).…”

Section: Maternal Nausea and Vomitingmentioning

confidence: 99%

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Prevention of spinal hypotension during cesarean section: A systematic review and Bayesian network meta‐analysis based on ephedrine, phenylephrine, and norepinephrine

Xue

Zhou

et al. 2023

J of Obstet and Gynaecol

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The aim of this study is to perform a Bayesian network meta-analysis to evaluate the safety and efficacy of prophylactic bolus of different doses of ephedrine, phenylephrine, and norepinephrine for the prevention of spinal hypotension during cesarean section. Methods: The Web of Science, PubMed, EMBASE, Cochrane Library were searched until to May 20, 2022. The indicators included incidence of hypotension, reactive hypertension, bradycardia, nausea and vomiting, umbilical artery pH, and Apgar scores. Results: About 3125 related records were obtained and 17 RCTs met our eligibility criteria. Based on the results, prophylactic bolus injection of 21-30 mg ephedrine (82%) was the best efficacious option for preventing hypotension, followed by 13-16 μg norepinephrine and 81-120 mg phenylephrine; 121-150 μg phenylephrine had the highest probability (62%) caused reactive hypertension, followed by 11-30 mg ephedrine; phenylephrine was most likely to cause bradycardia in a dose-dependent manner; 81-120 μg phenylephrine had the highest probability (37%) which associated with IONV; 6-12 μg norepinephrine (31%) had the lowest influence on IONV and had highest probability (34%) associated with improving umbilical arterial pH; 13-16 μg norepinephrine had highest probability (67% at 1 min, 49% at 5 min) which associated with improving Apgar scores. Conclusions: Based on this study, 5-10 mg ephedrine and 13-16 μg norepinephrine prophylactic bolus injection may be the optimum dosage of three drugs prevent spinal-induced hypotension, which has the least impact on maternal and neonatal outcomes.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Incidence Of Maternal Hypotensionmentioning

confidence: 99%

Section: Maternal Bradycardiamentioning

confidence: 99%

Section: Maternal Nausea and Vomitingmentioning

confidence: 99%

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Prevention of spinal hypotension during cesarean section: A systematic review and Bayesian network meta‐analysis based on ephedrine, phenylephrine, and norepinephrine

Xue

Zhou

et al. 2023

J of Obstet and Gynaecol

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Comparison of the effect of different doses of phenylephrine infusion on the prevention of hypotension in the elderly under spinal anaesthesia in orthopaedic surgery

Golmohammadi,

Sane,

Kadhum

et al. 2024

Journal of Perioperative Practice

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Background: Considering the vasopressor drug categories and doses that can be used for elderly patients following hypotension are few, the present trial aimed to compare the effect of different doses of phenylephrine infusion on the prevention of hypotension in elderly patients undergoing orthopaedic lower extremities surgery. Methods: This randomised, double-blind prospective clinical trial was conducted by including 60 elderly patients older than 60 years and classified as American Society of Anesthesiology class I and II who were candidates for femur fracture fixation surgery. White and black cards randomly allocated patients to: group A (25µg/kg/h phenylephrine) or group B (35µg/kg/h phenylephrine). Results: At the T3-T7 time points, group A’s systolic and diastolic blood pressure was significantly higher than in group B’s (p < 0.05). However, after 27 minutes (T0-T7) of phenylephrine infusion, statistical analysis showed no significant difference between the two groups regarding blood pressure (T8-Tend). The frequency of bradycardia and reactive hypertension in group B were significantly higher than in group A (p = 0.02) and (p = 0.03), respectively. There was no significant difference between the bleeding loss, blood transfusion and crystalloid volume in both groups (p > 0.05). Conclusion: Our trial illustrated that high-dose phenylephrine infusion could not assure haemodynamic stability and may cause some side effects.

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Prevention of Oxytocin Induced Hypotension by Co- Administration of Different Doses of Phenylephrine With Oxytocin in Lower Segment Caesarean Section Under Sub Arachnoid Block: A Randomized Comparative Study

Verma

Sheikh²,

Maurya

et al. 2022

ijsr

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Objective: This study was designed to evaluate the efcacy of two prophylactic infusion dose of phenylephrine (50 and 75 μg) along with oxytocin to prevent oxytocin induced hypotension in parturients undergoing caesarean section. With institutional Ethical committeeMaterial and Method: (IEC) clearance and informed written consent, 420 term parturients undergoing elective caesarean section under SAB were randomly allocated to 3 groups of 140 each. Group C (3 IU oxytocin with normal saline) Group PE50 (3 IU oxytocin with phenylephrine 50μg) Group PE75 (3 IU oxytocin with phenylephrine 75μg) diluted to 10ml with normal saline and infused over 5 min after baby delivery. No of episode, incidence, duration of hypotension, rescue vasopressors requirement and any adverse effect observed. In present study, total 67(47.85%), 50 (35.71%) and 26Results: (18.57%) patients developed hypotension (P= 0.000) and total 110, 65 and 31 episodes (1.64±0.79, 1.30±0.54, 1.19±0.40 per patient) (P= 0.000) in group C, PE50 and PE75 respectively, total duration of hypotensive episode were 349, 217and 107 mins in three groups, and it consumed 131,75, 35 doses (50 μg each) of phenylephrine (1.95±1.13, 1.50±0.81,1.34± 0.48 dose Per patient) (P= 0.005) and total 97.76±56.69μg, 75 ±40.72 μg , 67.30 ±24.25 μg (p= 0.003) phenylephrine per patient as rescue vasopressors in group C, PE50 and PE75 respectively. TheConclusion: prophylactic co-administration of 75μg phenylephrine with oxytocin effectively reduced the incidence of oxytocin induced hypotension in term parturients undergoing caesarean section under subarachnoid block compared to 50μg phenylephrine.

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Prophylactic administration of two different bolus doses of phenylephrine for prevention of spinal-induced hypotension during cesarean section: A prospective double-blinded clinical study

Cited by 4 publications

References 26 publications

Prevention of spinal hypotension during cesarean section: A systematic review and Bayesian network meta‐analysis based on ephedrine, phenylephrine, and norepinephrine

Prevention of spinal hypotension during cesarean section: A systematic review and Bayesian network meta‐analysis based on ephedrine, phenylephrine, and norepinephrine

Comparison of the effect of different doses of phenylephrine infusion on the prevention of hypotension in the elderly under spinal anaesthesia in orthopaedic surgery

Prevention of Oxytocin Induced Hypotension by Co- Administration of Different Doses of Phenylephrine With Oxytocin in Lower Segment Caesarean Section Under Sub Arachnoid Block: A Randomized Comparative Study

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