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A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise.
Int J Obstet Anesth 2018; 33:23-31IJ

Abstract

BACKGROUND

Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia.

METHODS

Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5-15mg) or phenylephrine (50-100µg), to treat spinal hypotension. The primary outcome was umbilical arterial base excess. Secondary outcomes were umbilical arterial and venous pH and lactate concentration, venous base excess, and Apgar scores.

RESULTS

Among 133 women, 64 who required vasopressor treatment were randomised into groups of 32 with similar patient characteristics. Pre-delivery blood pressure changes were similar. There was no difference in mean [standard deviation] umbilical artery base excess (-4.9 [3.7] vs -6.0 [4.6] mmol/L for ephedrine and phenylephrine respectively; P=0.29). Mean umbilical arterial and venous pH and lactate concentrations did not significantly differ between groups (7.25 [0.08] vs 7.22 [0.10], 7.28 [0.07] vs 7.27 [0.10], and 3.41 [2.18] vs 3.28 [2.44] mmol/L respectively). Umbilical venous oxygen tension was higher in the ephedrine group (2.8 [0.7] vs 2.4 [0.62]) kPa, P=0.02). There was no difference in 1- or 5-min Apgar scores, numbers of neonates with 1-min Apgar scores <7 or with a pH <7.2.

CONCLUSIONS

In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension.

Authors+Show Affiliations

Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: robert.dyer@uct.ac.za.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL 60611, USA.Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St. F5-704, Chicago, IL 60611, USA.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Neonatology, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28899735

Citation

Dyer, R A., et al. "A Randomised Comparison of Bolus Phenylephrine and Ephedrine for the Management of Spinal Hypotension in Patients With Severe Preeclampsia and Fetal Compromise." International Journal of Obstetric Anesthesia, vol. 33, 2018, pp. 23-31.
Dyer RA, Emmanuel A, Adams SC, et al. A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. Int J Obstet Anesth. 2018;33:23-31.
Dyer, R. A., Emmanuel, A., Adams, S. C., Lombard, C. J., Arcache, M. J., Vorster, A., ... van Dyk, D. (2018). A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. International Journal of Obstetric Anesthesia, 33, pp. 23-31. doi:10.1016/j.ijoa.2017.08.001.
Dyer RA, et al. A Randomised Comparison of Bolus Phenylephrine and Ephedrine for the Management of Spinal Hypotension in Patients With Severe Preeclampsia and Fetal Compromise. Int J Obstet Anesth. 2018;33:23-31. PubMed PMID: 28899735.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. AU - Dyer,R A, AU - Emmanuel,A, AU - Adams,S C, AU - Lombard,C J, AU - Arcache,M J, AU - Vorster,A, AU - Wong,C A, AU - Higgins,N, AU - Reed,A R, AU - James,M F, AU - Joolay,Y, AU - Schulein,S, AU - van Dyk,D, Y1 - 2017/08/11/ PY - 2017/04/18/received PY - 2017/07/23/revised PY - 2017/08/05/accepted PY - 2017/9/14/pubmed PY - 2018/9/21/medline PY - 2017/9/14/entrez KW - Ephedrine KW - Fetal compromise KW - Phenylephrine KW - Preeclampsia KW - Spinal hypotension KW - Vasopressor SP - 23 EP - 31 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 33 N2 - BACKGROUND: Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia. METHODS: Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5-15mg) or phenylephrine (50-100µg), to treat spinal hypotension. The primary outcome was umbilical arterial base excess. Secondary outcomes were umbilical arterial and venous pH and lactate concentration, venous base excess, and Apgar scores. RESULTS: Among 133 women, 64 who required vasopressor treatment were randomised into groups of 32 with similar patient characteristics. Pre-delivery blood pressure changes were similar. There was no difference in mean [standard deviation] umbilical artery base excess (-4.9 [3.7] vs -6.0 [4.6] mmol/L for ephedrine and phenylephrine respectively; P=0.29). Mean umbilical arterial and venous pH and lactate concentrations did not significantly differ between groups (7.25 [0.08] vs 7.22 [0.10], 7.28 [0.07] vs 7.27 [0.10], and 3.41 [2.18] vs 3.28 [2.44] mmol/L respectively). Umbilical venous oxygen tension was higher in the ephedrine group (2.8 [0.7] vs 2.4 [0.62]) kPa, P=0.02). There was no difference in 1- or 5-min Apgar scores, numbers of neonates with 1-min Apgar scores <7 or with a pH <7.2. CONCLUSIONS: In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/28899735/A_randomised_comparison_of_bolus_phenylephrine_and_ephedrine_for_the_management_of_spinal_hypotension_in_patients_with_severe_preeclampsia_and_fetal_compromise_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(17)30172-3 DB - PRIME DP - Unbound Medicine ER -