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Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section.
Anesthesiology. 2001 Sep; 95(3):668-74.A

Abstract

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.

Authors+Show Affiliations

Département d'Anesthésie-Réanimation, Hĵpital Antoine Béclère, Clamart France. frederic.mercier@abc.ap-hop-paris.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

11575540

Citation

Mercier, F J., et al. "Phenylephrine Added to Prophylactic Ephedrine Infusion During Spinal Anesthesia for Elective Cesarean Section." Anesthesiology, vol. 95, no. 3, 2001, pp. 668-74.
Mercier FJ, Riley ET, Frederickson WL, et al. Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section. Anesthesiology. 2001;95(3):668-74.
Mercier, F. J., Riley, E. T., Frederickson, W. L., Roger-Christoph, S., Benhamou, D., & Cohen, S. E. (2001). Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section. Anesthesiology, 95(3), 668-74.
Mercier FJ, et al. Phenylephrine Added to Prophylactic Ephedrine Infusion During Spinal Anesthesia for Elective Cesarean Section. Anesthesiology. 2001;95(3):668-74. PubMed PMID: 11575540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section. AU - Mercier,F J, AU - Riley,E T, AU - Frederickson,W L, AU - Roger-Christoph,S, AU - Benhamou,D, AU - Cohen,S E, PY - 2001/9/29/pubmed PY - 2001/10/12/medline PY - 2001/9/29/entrez SP - 668 EP - 74 JF - Anesthesiology JO - Anesthesiology VL - 95 IS - 3 N2 - 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. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/11575540/Phenylephrine_added_to_prophylactic_ephedrine_infusion_during_spinal_anesthesia_for_elective_cesarean_section_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/00000542-200109000-00020 DB - PRIME DP - Unbound Medicine ER -