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Hemodynamic effects of spinal anesthesia and simultaneous intravenous bolus of combined phenylephrine and ephedrine versus ephedrine for cesarean delivery.
Int J Obstet Anesth 2005; 14(1):43-7IJ

Abstract

BACKGROUND

Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal symptoms and neonatal acid-base effects. Single-agent prophylaxis, most notably with ephedrine, does not reliably prevent spinal anesthesia-induced hypotension; recently, however, the prophylactic use of phenylephrine with ephedrine as an infusion was observed to be effective. We postulated that this combination, when given as an intravenous bolus for prophylaxis and rescue treatment, could be similarly effective.

METHOD

Forty-three term parturients were randomized to receive a bolus of ephedrine 10 mg +/- phenylephrine 40 microg (groups E and EP, respectively) simultaneously with spinal anesthesia. Hypotension was defined as a systolic blood pressure below 100 mmHg or a decrease of 20% from a baseline value. Rescue boluses comprised of ephedrine 5 mg +/- phenylephrine 20 microg.

RESULTS

For groups E and EP, respectively, the incidence of hypotension was 80% vs. 95% (P=0.339), with the mean number of rescue boluses being 3.85+/-3.7 and 3.05+/-1.7 and the mean umbilical artery pH being 7.246+/-0.081 vs. 7.244+/-0.106. All comparisons were not significant (NS).

CONCLUSION

The combination of ephedrine and phenylephrine given as an intravenous bolus at the doses selected is not superior to ephedrine alone in preventing or treating hypotension in healthy parturients undergoing cesarean delivery.

Authors+Show Affiliations

Department of Anesthesia, Pain & Perioperative Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.No 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

15627538

Citation

Loughrey, J P R., et al. "Hemodynamic Effects of Spinal Anesthesia and Simultaneous Intravenous Bolus of Combined Phenylephrine and Ephedrine Versus Ephedrine for Cesarean Delivery." International Journal of Obstetric Anesthesia, vol. 14, no. 1, 2005, pp. 43-7.
Loughrey JP, Yao N, Datta S, et al. Hemodynamic effects of spinal anesthesia and simultaneous intravenous bolus of combined phenylephrine and ephedrine versus ephedrine for cesarean delivery. Int J Obstet Anesth. 2005;14(1):43-7.
Loughrey, J. P., Yao, N., Datta, S., Segal, S., Pian-Smith, M., & Tsen, L. C. (2005). Hemodynamic effects of spinal anesthesia and simultaneous intravenous bolus of combined phenylephrine and ephedrine versus ephedrine for cesarean delivery. International Journal of Obstetric Anesthesia, 14(1), pp. 43-7.
Loughrey JP, et al. Hemodynamic Effects of Spinal Anesthesia and Simultaneous Intravenous Bolus of Combined Phenylephrine and Ephedrine Versus Ephedrine for Cesarean Delivery. Int J Obstet Anesth. 2005;14(1):43-7. PubMed PMID: 15627538.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of spinal anesthesia and simultaneous intravenous bolus of combined phenylephrine and ephedrine versus ephedrine for cesarean delivery. AU - Loughrey,J P R, AU - Yao,N, AU - Datta,S, AU - Segal,S, AU - Pian-Smith,M, AU - Tsen,L C, PY - 2004/07/01/accepted PY - 2005/1/4/pubmed PY - 2005/3/18/medline PY - 2005/1/4/entrez SP - 43 EP - 7 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 14 IS - 1 N2 - BACKGROUND: Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal symptoms and neonatal acid-base effects. Single-agent prophylaxis, most notably with ephedrine, does not reliably prevent spinal anesthesia-induced hypotension; recently, however, the prophylactic use of phenylephrine with ephedrine as an infusion was observed to be effective. We postulated that this combination, when given as an intravenous bolus for prophylaxis and rescue treatment, could be similarly effective. METHOD: Forty-three term parturients were randomized to receive a bolus of ephedrine 10 mg +/- phenylephrine 40 microg (groups E and EP, respectively) simultaneously with spinal anesthesia. Hypotension was defined as a systolic blood pressure below 100 mmHg or a decrease of 20% from a baseline value. Rescue boluses comprised of ephedrine 5 mg +/- phenylephrine 20 microg. RESULTS: For groups E and EP, respectively, the incidence of hypotension was 80% vs. 95% (P=0.339), with the mean number of rescue boluses being 3.85+/-3.7 and 3.05+/-1.7 and the mean umbilical artery pH being 7.246+/-0.081 vs. 7.244+/-0.106. All comparisons were not significant (NS). CONCLUSION: The combination of ephedrine and phenylephrine given as an intravenous bolus at the doses selected is not superior to ephedrine alone in preventing or treating hypotension in healthy parturients undergoing cesarean delivery. SN - 0959-289X UR - https://www.unboundmedicine.com/medline/citation/15627538/Hemodynamic_effects_of_spinal_anesthesia_and_simultaneous_intravenous_bolus_of_combined_phenylephrine_and_ephedrine_versus_ephedrine_for_cesarean_delivery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(04)00101-3 DB - PRIME DP - Unbound Medicine ER -