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Influence of phenylephrine or ephedrine on maternal hemodynamics upon umbilical cord clamping during cesarean delivery.
Int J Clin Pharmacol Ther. 2013 Nov; 51(11):888-94.IJ

Abstract

BACKGROUND AND OBJECTIVE

Vasopressors ephedrine and phenylephrine are commonly used with spinal anesthesia during cesarean delivery. Studies on them have focused on the period before the umbilical cord is clamped, although anesthesia is continuously administered throughout and after this event. This study aimed to compare the effects of these drugs on maternal hemodynamics at and after clamping of the umbilical cord.

STUDY DESIGN

Prospective, randomized, double-blind study.

SETTING

Parturients (n = 60) scheduled for elective cesarean delivery were randomly divided into an ephedrine group and a phenylephrine group. Each woman received an intrathecal injection of bupivacaine (7.5 mg).

MEASUREMENTS

Patients in the ephedrine and phenylephrine groups were infused continuously with ephedrine (0.02 mg×kg-1×min-1) or phenylephrine (0.25 μg×kg-1×min-1), respectively, from immediately after the injection of bupivacaine until termination 10 minutes after the umbilical cord was clamped (the endpoint). Hemodynamic changes were recorded.

RESULTS

After clamping the umbilical cord, the patients who were administered ephedrine experienced significant increases in heart rate (89 ± 11 beats/min to 106 ± 15 beats/min), cardiac output (6.4 ± 0.9 l/min to 7.6 ± 1.2 l/min) and cardiac index (3.5 ± 0.39 l×min-1×m-2 to 4.3 ± 0.48 l×min-1×m-2), while the systemic vascular resistance decreased (908 ± 296 dyne·s/cm5 to 711 ± 285 dyne·s/cm5). Such differences were not observed in the patients who received phenylephrine. Moreover, the heart rate of patients administered ephedrine was higher than that of patients given phenylephrine after clamping the umbilical cord.

CONCLUSION

Continuous infusion of phenylephrine during cesarean delivery maintains a stable maternal hemodynamic status better than ephedrine.

Authors

No 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

24040856

Citation

Quan, Zhefeng, et al. "Influence of Phenylephrine or Ephedrine On Maternal Hemodynamics Upon Umbilical Cord Clamping During Cesarean Delivery." International Journal of Clinical Pharmacology and Therapeutics, vol. 51, no. 11, 2013, pp. 888-94.
Quan Z, Tian M, Chi P, et al. Influence of phenylephrine or ephedrine on maternal hemodynamics upon umbilical cord clamping during cesarean delivery. Int J Clin Pharmacol Ther. 2013;51(11):888-94.
Quan, Z., Tian, M., Chi, P., Cao, Y., Li, X., & Peng, K. (2013). Influence of phenylephrine or ephedrine on maternal hemodynamics upon umbilical cord clamping during cesarean delivery. International Journal of Clinical Pharmacology and Therapeutics, 51(11), 888-94. https://doi.org/10.5414/CP201974
Quan Z, et al. Influence of Phenylephrine or Ephedrine On Maternal Hemodynamics Upon Umbilical Cord Clamping During Cesarean Delivery. Int J Clin Pharmacol Ther. 2013;51(11):888-94. PubMed PMID: 24040856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of phenylephrine or ephedrine on maternal hemodynamics upon umbilical cord clamping during cesarean delivery. AU - Quan,Zhefeng, AU - Tian,Ming, AU - Chi,Ping, AU - Cao,Yinghao, AU - Li,Xin, AU - Peng,Kejun, PY - 2013/10/24/accepted PY - 2013/9/18/entrez PY - 2013/9/18/pubmed PY - 2014/1/17/medline SP - 888 EP - 94 JF - International journal of clinical pharmacology and therapeutics JO - Int J Clin Pharmacol Ther VL - 51 IS - 11 N2 - BACKGROUND AND OBJECTIVE: Vasopressors ephedrine and phenylephrine are commonly used with spinal anesthesia during cesarean delivery. Studies on them have focused on the period before the umbilical cord is clamped, although anesthesia is continuously administered throughout and after this event. This study aimed to compare the effects of these drugs on maternal hemodynamics at and after clamping of the umbilical cord. STUDY DESIGN: Prospective, randomized, double-blind study. SETTING: Parturients (n = 60) scheduled for elective cesarean delivery were randomly divided into an ephedrine group and a phenylephrine group. Each woman received an intrathecal injection of bupivacaine (7.5 mg). MEASUREMENTS: Patients in the ephedrine and phenylephrine groups were infused continuously with ephedrine (0.02 mg×kg-1×min-1) or phenylephrine (0.25 μg×kg-1×min-1), respectively, from immediately after the injection of bupivacaine until termination 10 minutes after the umbilical cord was clamped (the endpoint). Hemodynamic changes were recorded. RESULTS: After clamping the umbilical cord, the patients who were administered ephedrine experienced significant increases in heart rate (89 ± 11 beats/min to 106 ± 15 beats/min), cardiac output (6.4 ± 0.9 l/min to 7.6 ± 1.2 l/min) and cardiac index (3.5 ± 0.39 l×min-1×m-2 to 4.3 ± 0.48 l×min-1×m-2), while the systemic vascular resistance decreased (908 ± 296 dyne·s/cm5 to 711 ± 285 dyne·s/cm5). Such differences were not observed in the patients who received phenylephrine. Moreover, the heart rate of patients administered ephedrine was higher than that of patients given phenylephrine after clamping the umbilical cord. CONCLUSION: Continuous infusion of phenylephrine during cesarean delivery maintains a stable maternal hemodynamic status better than ephedrine. SN - 0946-1965 UR - https://www.unboundmedicine.com/medline/citation/24040856/Influence_of_phenylephrine_or_ephedrine_on_maternal_hemodynamics_upon_umbilical_cord_clamping_during_cesarean_delivery_ L2 - http://www.dustri.com/nc/journals-in-english.html?artId=10876 DB - PRIME DP - Unbound Medicine ER -