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Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial.
J Clin Anesth 2017; 37:43-48JC

Abstract

Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05].

Authors+Show Affiliations

University College London Hospitals NHS Foundation Trust, London, UK.University College London Hospitals NHS Foundation Trust, London, UK.University College London Hospitals NHS Foundation Trust, London, UK.St.Richard's Hospital, Chichester, UK.University College London Hospitals NHS Foundation Trust, London, UK.Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK.Princess Alexandra Hospital, Harlow, UK.University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, UK.University College London Hospitals NHS Foundation Trust, London, UK.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

28235526

Citation

Mon, W, et al. "Cardiac Output Changes With Phenylephrine and Ephedrine Infusions During Spinal Anesthesia for Cesarean Section: a Randomized, Double-blind Trial." Journal of Clinical Anesthesia, vol. 37, 2017, pp. 43-48.
Mon W, Stewart A, Fernando R, et al. Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. J Clin Anesth. 2017;37:43-48.
Mon, W., Stewart, A., Fernando, R., Ashpole, K., El-Wahab, N., MacDonald, S., ... Liu, Y. M. (2017). Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. Journal of Clinical Anesthesia, 37, pp. 43-48. doi:10.1016/j.jclinane.2016.11.001.
Mon W, et al. Cardiac Output Changes With Phenylephrine and Ephedrine Infusions During Spinal Anesthesia for Cesarean Section: a Randomized, Double-blind Trial. J Clin Anesth. 2017;37:43-48. PubMed PMID: 28235526.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cardiac output changes with phenylephrine and ephedrine infusions during spinal anesthesia for cesarean section: A randomized, double-blind trial. AU - Mon,W, AU - Stewart,A, AU - Fernando,R, AU - Ashpole,K, AU - El-Wahab,N, AU - MacDonald,S, AU - Tamilselvan,P, AU - Columb,M, AU - Liu,Y M, Y1 - 2016/12/26/ PY - 2016/04/26/received PY - 2016/10/14/revised PY - 2016/11/03/accepted PY - 2017/2/26/entrez PY - 2017/2/27/pubmed PY - 2017/9/15/medline KW - Cardiac output KW - Cesarean section KW - Ephedrine KW - Fetal acidosis KW - Hypotension KW - Phenylephrine SP - 43 EP - 48 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 37 N2 - Hypotension is a common side effect of spinal anesthesia. Phenylephrine and ephedrine are the two most frequently used vasopressors to treat spinal hypotension during cesarean delivery. In this randomized double-blind study, we aimed to evaluate cardiac output (CO) changes with phenylephrine or ephedrine infusions titrated to maintain baseline systolic blood pressure (bSBP) during spinal anesthesia. Women (n = 40) scheduled for elective cesarean delivery received either phenylephrine 100 μg/min or ephedrine 5 mg/min infusions. Baseline hemodynamics (cardiac output, heart rate, systolic blood pressure) were recorded in the left lateral tilt position before fluid preload, and recorded every minute after spinal anesthesia until delivery. Umbilical cord blood gases were analyzed within 5 minutes of delivery. Good systolic blood pressure control was attained in both groups with minimal periods of hypotension (SBP <80% of bSBP) or hypertension (SBP >120% of bSBP). Cardiac output and heart rate increased over time with ephedrine, but decreased with phenylephrine. The maximum increase in CO from the baseline was 12%, in the ephedrine group, and this occurred 20 minutes after spinal injection. Cardiac output fell by more than 17% in the phenylephrine group, maximal at 10 minutes following spinal injection. Despite good systolic blood pressure control and increased cardiac output with ephedrine, administration of ephedrine was associated with significantly more fetal acidosis [Median (Interquartile range, IQR) UApH - phenylephrine = 7.33 (7.31-7.34) and ephedrine = 7.22 (7.16-7.27), P < .05]. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/28235526/Cardiac_output_changes_with_phenylephrine_and_ephedrine_infusions_during_spinal_anesthesia_for_cesarean_section:_A_randomized_double_blind_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(16)30915-1 DB - PRIME DP - Unbound Medicine ER -