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Randomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise.
Int J Obstet Anesth 2016; 27:32-40IJ

Abstract

BACKGROUND

Most studies comparing phenylephrine and ephedrine have been conducted during elective caesarean sections in healthy mothers with no fetal compromise. The effect of vasopressors on fetal outcome may differ between healthy and compromised fetuses. There has been little research into the effect of phenylephrine and ephedrine, when used for management of post-spinal hypotension in the presence of potential fetal compromise.

METHODS

Healthy women with a singleton pregnancy undergoing emergency caesarean section for fetal compromise under spinal anaesthesia were studied. One-hundred-and-six consecutive subjects, who developed hypotension after spinal anaesthesia, were randomly allocated to two groups of 53 each, to receive either phenylephrine (Group P) or ephedrine (Group E). For every systolic blood pressure reading <100mmHg patients received phenylephrine 100μg or ephedrine 8mg depending on group allocation. Umbilical blood gas parameters and Apgar scores were recorded.

RESULTS

There was no statistically significant difference in umbilical arterial pH (P=0.79), umbilical venous pH (P=0.98), other blood gas parameters, incidence of fetal acidosis (P=1.00) and Apgar scores. The number of hypotensive episodes, vasopressor doses for treatment of the first hypotensive episode and the total number of doses used during the study period were comparable. The median [IQR] total number of doses of phenylephrine and ephedrine used before delivery were 2 [1-2] and 2 [1-2], respectively (P=0.67). More patients receiving ephedrine (24.5%) developed tachycardia than those receiving phenylephrine (3.8%) (P=0.004). Bradycardia was more common with phenylephrine, with 39.6% of patients in Group P as compared to only 1.9% of patients in Group E developing a heart rate <60beats/min after vasopressor administration (P=0.001).

CONCLUSIONS

Both phenylephrine 100μg and ephedrine 8mg boluses are equally efficacious when treating post-spinal hypotension in the presence of potential fetal compromise. However, phenylephrine may be a better choice in the presence of maternal tachycardia.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. Electronic address: medhamohta@hotmail.com.Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27020488

Citation

Mohta, M, et al. "Randomized Double-blind Comparison of Ephedrine and Phenylephrine for Management of Post-spinal Hypotension in Potential Fetal Compromise." International Journal of Obstetric Anesthesia, vol. 27, 2016, pp. 32-40.
Mohta M, Aggarwal M, Sethi AK, et al. Randomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise. Int J Obstet Anesth. 2016;27:32-40.
Mohta, M., Aggarwal, M., Sethi, A. K., Harisinghani, P., & Guleria, K. (2016). Randomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise. International Journal of Obstetric Anesthesia, 27, pp. 32-40. doi:10.1016/j.ijoa.2016.02.004.
Mohta M, et al. Randomized Double-blind Comparison of Ephedrine and Phenylephrine for Management of Post-spinal Hypotension in Potential Fetal Compromise. Int J Obstet Anesth. 2016;27:32-40. PubMed PMID: 27020488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise. AU - Mohta,M, AU - Aggarwal,M, AU - Sethi,A K, AU - Harisinghani,P, AU - Guleria,K, Y1 - 2016/02/21/ PY - 2015/09/08/received PY - 2016/02/05/revised PY - 2016/02/14/accepted PY - 2016/3/30/entrez PY - 2016/3/30/pubmed PY - 2017/9/20/medline KW - Caesarean section KW - Ephedrine KW - Fetal compromise KW - Phenylephrine KW - Spinal anaesthesia SP - 32 EP - 40 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 27 N2 - BACKGROUND: Most studies comparing phenylephrine and ephedrine have been conducted during elective caesarean sections in healthy mothers with no fetal compromise. The effect of vasopressors on fetal outcome may differ between healthy and compromised fetuses. There has been little research into the effect of phenylephrine and ephedrine, when used for management of post-spinal hypotension in the presence of potential fetal compromise. METHODS: Healthy women with a singleton pregnancy undergoing emergency caesarean section for fetal compromise under spinal anaesthesia were studied. One-hundred-and-six consecutive subjects, who developed hypotension after spinal anaesthesia, were randomly allocated to two groups of 53 each, to receive either phenylephrine (Group P) or ephedrine (Group E). For every systolic blood pressure reading <100mmHg patients received phenylephrine 100μg or ephedrine 8mg depending on group allocation. Umbilical blood gas parameters and Apgar scores were recorded. RESULTS: There was no statistically significant difference in umbilical arterial pH (P=0.79), umbilical venous pH (P=0.98), other blood gas parameters, incidence of fetal acidosis (P=1.00) and Apgar scores. The number of hypotensive episodes, vasopressor doses for treatment of the first hypotensive episode and the total number of doses used during the study period were comparable. The median [IQR] total number of doses of phenylephrine and ephedrine used before delivery were 2 [1-2] and 2 [1-2], respectively (P=0.67). More patients receiving ephedrine (24.5%) developed tachycardia than those receiving phenylephrine (3.8%) (P=0.004). Bradycardia was more common with phenylephrine, with 39.6% of patients in Group P as compared to only 1.9% of patients in Group E developing a heart rate <60beats/min after vasopressor administration (P=0.001). CONCLUSIONS: Both phenylephrine 100μg and ephedrine 8mg boluses are equally efficacious when treating post-spinal hypotension in the presence of potential fetal compromise. However, phenylephrine may be a better choice in the presence of maternal tachycardia. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/27020488/Randomized_double_blind_comparison_of_ephedrine_and_phenylephrine_for_management_of_post_spinal_hypotension_in_potential_fetal_compromise_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(16)00033-9 DB - PRIME DP - Unbound Medicine ER -