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Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery.
Anesthesiology 2009; 111(4):753-65A

Abstract

BACKGROUND

Hemodynamic responses to vasopressors used during spinal anesthesia for elective Cesarean delivery, have not been well described. This study compared the effects of bolus phenylephrine and ephedrine on maternal cardiac output (CO). The hypothesis was that phenylephrine, but not ephedrine, decreases CO when administered in response to hypotension during spinal anesthesia.

METHODS

Forty-three patients were randomized to receive 80 microg of phenylephrine or 10 mg of ephedrine. Both pulse wave form analysis and transthoracic bioimpedance changes were used to estimate stroke volume in each patient. Hemodynamic responses to spinal anesthesia and oxytocin were also recorded. A subgroup of 20 patients was randomized to receive oxytocin compared with oxytocin plus 80 microg of phenylephrine after delivery.

RESULTS

Mean CO and maximum absolute response in CO were significantly lower during the 150 s after phenylephrine administration than after ephedrine (6.2 vs. 8.1 l/min, P = 0.001, and 5.2 vs. 9.0 l/min, P < 0.0001, respectively for pulse wave form analysis, and 5.2 vs. 6.3 l/min, P = 0.01 and 4.5 vs. 6.7 l/min, P = 0.0001, respectively for bioimpedance changes). CO changes correlated with heart rate changes. Coadministration of phenylephrine obtunded oxytocin-induced decreases in systemic vascular resistance and increases in heart rate and CO. Trends in CO change were similar using either monitor.

CONCLUSIONS

Bolus phenylephrine reduced maternal CO, and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery. CO changes correlated with heart rate changes after vasopressor administration, emphasizing the importance of heart rate as a surrogate indicator of CO. Coadministered phenylephrine obtunded hemodynamic responses to oxytocin.

Authors+Show Affiliations

Department of Anesthesia, University of Cape Town and New Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, South Africa. robert.dyer@uct.ac.zaNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19741494

Citation

Dyer, Robert A., et al. "Hemodynamic Effects of Ephedrine, Phenylephrine, and the Coadministration of Phenylephrine With Oxytocin During Spinal Anesthesia for Elective Cesarean Delivery." Anesthesiology, vol. 111, no. 4, 2009, pp. 753-65.
Dyer RA, Reed AR, van Dyk D, et al. Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology. 2009;111(4):753-65.
Dyer, R. A., Reed, A. R., van Dyk, D., Arcache, M. J., Hodges, O., Lombard, C. J., ... James, M. F. (2009). Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. Anesthesiology, 111(4), pp. 753-65. doi:10.1097/ALN.0b013e3181b437e0.
Dyer RA, et al. Hemodynamic Effects of Ephedrine, Phenylephrine, and the Coadministration of Phenylephrine With Oxytocin During Spinal Anesthesia for Elective Cesarean Delivery. Anesthesiology. 2009;111(4):753-65. PubMed PMID: 19741494.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. AU - Dyer,Robert A, AU - Reed,Anthony R, AU - van Dyk,Dominique, AU - Arcache,Michelle J, AU - Hodges,Owen, AU - Lombard,Carl J, AU - Greenwood,Jaime, AU - James,Michael F, PY - 2009/9/11/entrez PY - 2009/9/11/pubmed PY - 2010/1/13/medline SP - 753 EP - 65 JF - Anesthesiology JO - Anesthesiology VL - 111 IS - 4 N2 - BACKGROUND: Hemodynamic responses to vasopressors used during spinal anesthesia for elective Cesarean delivery, have not been well described. This study compared the effects of bolus phenylephrine and ephedrine on maternal cardiac output (CO). The hypothesis was that phenylephrine, but not ephedrine, decreases CO when administered in response to hypotension during spinal anesthesia. METHODS: Forty-three patients were randomized to receive 80 microg of phenylephrine or 10 mg of ephedrine. Both pulse wave form analysis and transthoracic bioimpedance changes were used to estimate stroke volume in each patient. Hemodynamic responses to spinal anesthesia and oxytocin were also recorded. A subgroup of 20 patients was randomized to receive oxytocin compared with oxytocin plus 80 microg of phenylephrine after delivery. RESULTS: Mean CO and maximum absolute response in CO were significantly lower during the 150 s after phenylephrine administration than after ephedrine (6.2 vs. 8.1 l/min, P = 0.001, and 5.2 vs. 9.0 l/min, P < 0.0001, respectively for pulse wave form analysis, and 5.2 vs. 6.3 l/min, P = 0.01 and 4.5 vs. 6.7 l/min, P = 0.0001, respectively for bioimpedance changes). CO changes correlated with heart rate changes. Coadministration of phenylephrine obtunded oxytocin-induced decreases in systemic vascular resistance and increases in heart rate and CO. Trends in CO change were similar using either monitor. CONCLUSIONS: Bolus phenylephrine reduced maternal CO, and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery. CO changes correlated with heart rate changes after vasopressor administration, emphasizing the importance of heart rate as a surrogate indicator of CO. Coadministered phenylephrine obtunded hemodynamic responses to oxytocin. SN - 1528-1175 UR - https://www.unboundmedicine.com/medline/citation/19741494/Hemodynamic_effects_of_ephedrine_phenylephrine_and_the_coadministration_of_phenylephrine_with_oxytocin_during_spinal_anesthesia_for_elective_cesarean_delivery_ L2 - http://anesthesiology.pubs.asahq.org/article.aspx?doi=10.1097/ALN.0b013e3181b437e0 DB - PRIME DP - Unbound Medicine ER -