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[Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: a randomized comparative trial].
Rev Esp Anestesiol Reanim 2011 Aug-Sep; 58(7):412-6RE

Abstract

OBJECTIVE

Subarachnoid spinal anesthesia for cesarean section is associated with a high incidence of hypotension, which can require the use of vasoconstrictors. The aim of this trial was to compare ephedrine to phenylephrine for the prevention of secondary hypotension and to assess the adverse effects on both mother and newborn.

MATERIAL AND METHODS

Eighty patients undergoing elective or emergency cesarean section, in the absence of uterine activity or fetal risk, were randomized to receive prophylaxis with ephedrine or phenylephrine immediately after the spinal block. Patients in the ephedrine group received an intravenous bolus of 0.1 mg/kg plus continuous infusion at a rate of 0.5 mg/kg/h; patients in the phenylephrine group received an intravenous bolus of 1.5 microg/kg plus a continuous infusion at 1.5 microg/kg/min. Infusion was maintained until umbilical cord clamping. We recorded maternal blood pressure, heart rate, nausea and vomiting, dizziness, bradycardia, hypotension, hypertension, fetal Apgar index, and umbilical cord blood parameters (pH, PCO2, and HCO3).

RESULTS

The overall incidence of hypotension was 11.2%, with no significant between-group differences (ephedrine group, 11.4%; phenylephrine group, 11.1%). The incidences of hypertension and bradycardia were higher in the phenylephrine group (27.8% and 2.3%, respectively) than in the ephedrine group (25% and 0%, respectively). Umbilical cord blood parameters and Apgar scores were similar. After suspension of continuous infusion, an episode of hypotension was detected in 22.5% of the patients (72.2% of these patients were in the phenylephrine group and 27.8% were in the ephedrine group).

CONCLUSIONS

At the doses of ephedrine and phenylephrine administered in this trial, the ability of these drugs to prevent hypotension during cesarean section proved to be similar. Higher incidences of adverse events (hypertension and bradycardia) were observed in the phenylephrine group. No differences were observed in neonatal effects.

Authors+Show Affiliations

Hospital Universitario La Princesa, Madrid. kikealday@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial

Language

spa

PubMed ID

22046862

Citation

Alday Muñoz, E, et al. "[Ephedrine Vs. Phenylephrine By Intravenous Bolus and Continuous Infusion to Prevent Hypotension Secondary to Spinal Anesthesia During Cesarean Section: a Randomized Comparative Trial]." Revista Espanola De Anestesiologia Y Reanimacion, vol. 58, no. 7, 2011, pp. 412-6.
Alday Muñoz E, Palacio Abizanda F, De Diego Pdel R, et al. [Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: a randomized comparative trial]. Rev Esp Anestesiol Reanim. 2011;58(7):412-6.
Alday Muñoz, E., Palacio Abizanda, F., De Diego, P. d. e. l. . R., & Gilsanz Rodríguez, F. (2011). [Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: a randomized comparative trial]. Revista Espanola De Anestesiologia Y Reanimacion, 58(7), pp. 412-6.
Alday Muñoz E, et al. [Ephedrine Vs. Phenylephrine By Intravenous Bolus and Continuous Infusion to Prevent Hypotension Secondary to Spinal Anesthesia During Cesarean Section: a Randomized Comparative Trial]. Rev Esp Anestesiol Reanim. 2011;58(7):412-6. PubMed PMID: 22046862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Ephedrine vs. phenylephrine by intravenous bolus and continuous infusion to prevent hypotension secondary to spinal anesthesia during cesarean section: a randomized comparative trial]. AU - Alday Muñoz,E, AU - Palacio Abizanda,F, AU - De Diego,P del Rey, AU - Gilsanz Rodríguez,F, PY - 2011/11/4/entrez PY - 2011/11/4/pubmed PY - 2012/1/4/medline SP - 412 EP - 6 JF - Revista espanola de anestesiologia y reanimacion JO - Rev Esp Anestesiol Reanim VL - 58 IS - 7 N2 - OBJECTIVE: Subarachnoid spinal anesthesia for cesarean section is associated with a high incidence of hypotension, which can require the use of vasoconstrictors. The aim of this trial was to compare ephedrine to phenylephrine for the prevention of secondary hypotension and to assess the adverse effects on both mother and newborn. MATERIAL AND METHODS: Eighty patients undergoing elective or emergency cesarean section, in the absence of uterine activity or fetal risk, were randomized to receive prophylaxis with ephedrine or phenylephrine immediately after the spinal block. Patients in the ephedrine group received an intravenous bolus of 0.1 mg/kg plus continuous infusion at a rate of 0.5 mg/kg/h; patients in the phenylephrine group received an intravenous bolus of 1.5 microg/kg plus a continuous infusion at 1.5 microg/kg/min. Infusion was maintained until umbilical cord clamping. We recorded maternal blood pressure, heart rate, nausea and vomiting, dizziness, bradycardia, hypotension, hypertension, fetal Apgar index, and umbilical cord blood parameters (pH, PCO2, and HCO3). RESULTS: The overall incidence of hypotension was 11.2%, with no significant between-group differences (ephedrine group, 11.4%; phenylephrine group, 11.1%). The incidences of hypertension and bradycardia were higher in the phenylephrine group (27.8% and 2.3%, respectively) than in the ephedrine group (25% and 0%, respectively). Umbilical cord blood parameters and Apgar scores were similar. After suspension of continuous infusion, an episode of hypotension was detected in 22.5% of the patients (72.2% of these patients were in the phenylephrine group and 27.8% were in the ephedrine group). CONCLUSIONS: At the doses of ephedrine and phenylephrine administered in this trial, the ability of these drugs to prevent hypotension during cesarean section proved to be similar. Higher incidences of adverse events (hypertension and bradycardia) were observed in the phenylephrine group. No differences were observed in neonatal effects. SN - 0034-9356 UR - https://www.unboundmedicine.com/medline/citation/22046862/[Ephedrine_vs__phenylephrine_by_intravenous_bolus_and_continuous_infusion_to_prevent_hypotension_secondary_to_spinal_anesthesia_during_cesarean_section:_a_randomized_comparative_trial]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0034-9356(11)70104-9 DB - PRIME DP - Unbound Medicine ER -