Spinal anaesthesia for Caesarean section: comparison of infusions of phenylephrine and ephedrine

Hall, Paula A.; Bennett, Alexander I.; Wilkes, M.; Lewis, Michael Bevan

doi:10.1093/bja/73.4.471

Cited by 138 publications

(89 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite early reports suggesting that use of agonists was associated with adverse fetal effects 6,21 ; more recently performed comparative studies have shown that agonists are associated with better fetal acid-base status and maternal nausea and vomiting than ephedrine 2. Regarding phenylephrine, studies show that prophylactic phenylephrine infusion at LSCS is better than phenylephrine boluses to prevent hypotension during surgery. 4 .…”

Section: Discussionmentioning

confidence: 99%

Use of phenylephrine as vasopressor of choice to prevent hypotension following spinal anaesthesia in LSCS

Pinto

Jaysundara

Abeysundara

et al. 2009

Sri Lankan J Anaesthesiol

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Use of phenylephrine as vasopressor of choice to prevent hypotension following spinal anaesthesia in LSCS

Pinto

Jaysundara

Abeysundara

et al. 2009

Sri Lankan J Anaesthesiol

View full text Add to dashboard Cite

“…The total dose of phenylephrine given to patients in our study was greater than that reported in studies by other investigators [1,10,11]. However, our technique was based on our previous studies [2][3][4] in which we have not observed adverse neonatal effects despite similarly large doses of phenylephrine.…”

Section: Discussionmentioning

confidence: 78%

Closed‐loop feedback computer‐controlled infusion of phenylephrine for maintaining blood pressure during spinal anaesthesia for caesarean section: a preliminary descriptive study*

Kee

Tam²,

Khaw

et al. 2007

Anaesthesia

View full text Add to dashboard Cite

SummaryWe describe the novel use of a closed-loop feedback computer-controlled infusion of phenylephrine for maintaining blood pressure in 53 patients having spinal anaesthesia for elective caesarean section. A simple on-off algorithm was used that activated an intravenous phenylephrine infusion at 100 lg.min )1 when systolic blood pressure was less than or equal to baseline and stopped the infusion when systolic blood pressure exceeded baseline. Up to uterine incision, 94.6% of all systolic blood pressure measurements were within the range (baseline ± 20%). Seven patients (13.2%) had one or more episodes of hypotension (systolic blood pressure < 80% of baseline) and 23 patients (37.7%) had one or more episodes of hypertension (systolic blood pressure > 120% of baseline). No patient had nausea or vomiting and in no case was umbilical arterial blood pH < 7.2. Calculated system performance parameters were comparable with those of previously published closed-loop systems and provide a reference for the potential development and comparison of more advanced algorithms. Recent studies have demonstrated the efficacy and clinical utility of phenylephrine infusions for maintaining maternal blood pressure during spinal anaesthesia for caesarean section [1][2][3][4]. Previously, this has been performed using a syringe or infusion pump with titration by manual rate adjustments according to the maternal blood pressure. Although this method is effective for maintaining maternal blood pressure and preventing adverse effects of hypotension on mother and fetus, manual titration can be labour-intensive and distracting. Thus, automation of the process has potential benefits. Delivery of drugs by closed-loop feedback computercontrolled infusion is well described in anaesthesia and other specialties and techniques for assessing the performance of such systems have been established [5,6]. However, this technique has not been applied to the administration of vasopressors for maintaining blood pressure during regional anaesthesia. The purpose of this investigation was to describe the use of closed-loop feedback computer-controlled infusion of phenylephrine for maintaining maternal blood pressure during spinal anaesthesia for elective caesarean section. In a preliminary study, we developed a simple computer-controlled on-off algorithm based on our previously described manual algorithm [2][3][4]. We aimed to evaluate its feasibility and performance and to establish a basis for the possible development of more advanced algorithms.

show abstract

“…The incidence of hypotension during spinal anaesthesia and CSE varies depending on the definition and technique used and has been estimated to be as high as 80% [14] Most studies define hypotension as a mean SBP less than 20-30% of the baseline or an absolute systolic pressure of less than 90-100 mmHg. Adigun et al [8] defined hypotension as reduction in SBP >30% of baseline value.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Infusions of Phenylephrine and Ephedrine during Combined Spinal Epidural Anaesthesia for Caesarean Section: A Comparative Study

S¹

2013

J Anesth Clin Res

View full text Add to dashboard Cite

Background: Hypotension is the most common adverse effect in parturients after spinal anaesthesia for Caesarean section. Despite various pharmacological and non-pharmacological methods used in its prevention and treatment, vasopressors have become very important in the management of this form of hypotension.Objective: This study was aimed at comparing the efficacy and safety of prophylactic intravenous infusions of phenylephrine and ephedrine at preventing maternal hypotension during Combined Spinal Epidural anaesthesia (CSE) for Caesarean section.Methods: Sixty ASA I and II patients scheduled for elective Caesarean section, were randomly allocated into two groups. Patients in Group I received Phenylephrine 80 μg/min while patients in Group II received Ephedrine 1 mg/min immediately after the subarachnoid 10 mg plain bupivacaine injection while the epidural catheter was being inserted and secured. All the patients received a crystalloid preload of 1 litre of 0.9% normal saline prior to the induction of CSE. Results:The overall incidence of hypotension was 8.5% (6.7% in the phenylephrine group and 10.3% in the ephedrine groups). The lowest systolic (105.8 ± 9.2 mmHg) and diastolic arterial pressures (60.9 ± 8.9 mmHg) occurred in the ephedrine group while the lowest heart rates occurred in the phenylephrine group. The mean umbilical artery pH was 7.3 while Apgar scores at 1 st and 5 th min were essentially the same in the two groups. Conclusion:Prophylactic intravenous infusions of phenylephrine and ephedrine are safe and effective at reducing the incidence and severity of hypotension during combined spinal epidural anaesthesia for elective Caesarean section with no associated neonatal acidosis.

show abstract

Spinal anaesthesia for Caesarean section: comparison of infusions of phenylephrine and ephedrine

Cited by 138 publications

References 0 publications

Use of phenylephrine as vasopressor of choice to prevent hypotension following spinal anaesthesia in LSCS

Use of phenylephrine as vasopressor of choice to prevent hypotension following spinal anaesthesia in LSCS

Closed‐loop feedback computer‐controlled infusion of phenylephrine for maintaining blood pressure during spinal anaesthesia for caesarean section: a preliminary descriptive study*

Prophylactic Infusions of Phenylephrine and Ephedrine during Combined Spinal Epidural Anaesthesia for Caesarean Section: A Comparative Study

Contact Info

Product

Resources

About