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A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise.
J Clin Anesth. 2016 Nov; 34:208-15.JC

Abstract

BACKGROUND

Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies.

METHODS

Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2.5mg/min or phenylephrine 30μg/min. Systolic blood pressure was targeted between 90% and 110% of baseline. Incidence of fetal acidosis (UA pH <7.2 and/or base deficit >12mmol/L) was recorded. Other parameters of cord gases, Apgar score, need for immediate resuscitation, maternal hemodynamics, and adverse events were also compared.

RESULTS

Number of neonates showing acidosis with ephedrine or phenylephrine was comparable (P=.22). Of these, newborns with base deficit >12mmol had low 1-minute Apgar scores (n=15/23). The ephedrine group had higher oxygen content in UA (P=.03). There was no adverse neonatal outcome during the period of observation. Incidence of maternal nausea and vomiting was higher with ephedrine than with phenylephrine (22.2% vs 4.4%; P=.02). Maternal bradycardia was observed with phenylephrine (P=.02).

CONCLUSION

Our data report similar fetal acidosis with either phenylephrine or ephedrine administered during spinal anesthesia for treating maternal hypotension in cases of emergency CD.

Authors+Show Affiliations

Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India. Electronic address: kajalteji@gmail.com.Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

27687377

Citation

Jain, Kajal, et al. "A Randomized Trial Comparing Prophylactic Phenylephrine and Ephedrine Infusion During Spinal Anesthesia for Emergency Cesarean Delivery in Cases of Acute Fetal Compromise." Journal of Clinical Anesthesia, vol. 34, 2016, pp. 208-15.
Jain K, Makkar JK, Subramani Vp S, et al. A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise. J Clin Anesth. 2016;34:208-15.
Jain, K., Makkar, J. K., Subramani Vp, S., Gander, S., & Kumar, P. (2016). A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise. Journal of Clinical Anesthesia, 34, 208-15. https://doi.org/10.1016/j.jclinane.2016.03.015
Jain K, et al. A Randomized Trial Comparing Prophylactic Phenylephrine and Ephedrine Infusion During Spinal Anesthesia for Emergency Cesarean Delivery in Cases of Acute Fetal Compromise. J Clin Anesth. 2016;34:208-15. PubMed PMID: 27687377.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise. AU - Jain,Kajal, AU - Makkar,Jeetinder Kaur, AU - Subramani Vp,Siva, AU - Gander,Shalini, AU - Kumar,Praveen, Y1 - 2016/05/12/ PY - 2015/11/04/received PY - 2016/03/03/revised PY - 2016/03/05/accepted PY - 2016/10/1/entrez PY - 2016/10/1/pubmed PY - 2017/8/5/medline KW - Anesthesia KW - Cesarean KW - Emergency, category II KW - Ephedrine, phenylephrine KW - Spinal, vasopressor SP - 208 EP - 15 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 34 N2 - BACKGROUND: Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies. METHODS: Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2.5mg/min or phenylephrine 30μg/min. Systolic blood pressure was targeted between 90% and 110% of baseline. Incidence of fetal acidosis (UA pH <7.2 and/or base deficit >12mmol/L) was recorded. Other parameters of cord gases, Apgar score, need for immediate resuscitation, maternal hemodynamics, and adverse events were also compared. RESULTS: Number of neonates showing acidosis with ephedrine or phenylephrine was comparable (P=.22). Of these, newborns with base deficit >12mmol had low 1-minute Apgar scores (n=15/23). The ephedrine group had higher oxygen content in UA (P=.03). There was no adverse neonatal outcome during the period of observation. Incidence of maternal nausea and vomiting was higher with ephedrine than with phenylephrine (22.2% vs 4.4%; P=.02). Maternal bradycardia was observed with phenylephrine (P=.02). CONCLUSION: Our data report similar fetal acidosis with either phenylephrine or ephedrine administered during spinal anesthesia for treating maternal hypotension in cases of emergency CD. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/27687377/A_randomized_trial_comparing_prophylactic_phenylephrine_and_ephedrine_infusion_during_spinal_anesthesia_for_emergency_cesarean_delivery_in_cases_of_acute_fetal_compromise_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(16)30027-7 DB - PRIME DP - Unbound Medicine ER -