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A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.
Can J Anaesth. 2018 03; 65(3):254-262.CJ

Abstract

PURPOSE

Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension.

METHODS

In this multicentre, double-blinded randomized controlled trial, 160 obese women undergoing elective Cesarean delivery under spinal anesthesia were randomized to receive a prophylactic phenylephrine infusion initiated at 50 μg·min-1 (and titrated according to a predefined algorithm) or 100 μg phenylephrine boluses to treat hypotension. Maternal systolic blood pressure was maintained within 20% of baseline. The primary study outcome was the incidence of IONV.

RESULTS

Intraoperative nausea and vomiting were significantly reduced in the infusion group compared to the bolus group (46% vs 75%, respectively; relative risk [RR], 0.61; 95% confidence interval [CI], 0.47 to 0.80; P < 0.001). This was associated with significantly reduced need for intraoperative rescue antiemetics (26% vs 42%, respectively; RR, 0.62; 95% CI, 0.40 to 0.97; P = 0.04), but no difference in the incidence of vomiting. Postoperative vomiting at two hours was reduced in the infusion group (11% vs 25%; RR, 0.44; 95% CI, 0.21 to 0.90; P = 0.02);however, there were no differences in the incidence or severity of postoperative nausea, need for rescue antiemetics at two hours and 24 hr, or the incidence of postoperative vomiting at 24 hr.

CONCLUSION

In obese women undergoing Cesarean delivery with spinal anesthesia, prophylactic phenylephrine infusion was associated with less intraoperative nausea, less need for rescue antiemetics, and reduced early postoperative vomiting.

TRIAL REGISTRATION

www.clinicaltrials.gov (NCT01481740). Registered 22 July 2011.

Authors+Show Affiliations

Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada. rbgeorge@dal.ca.Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada.Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.Department of Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, 5850/5980 University Avenue, P.O. Box 9700, Halifax, NS, B3K 6R8, Canada.Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29209926

Citation

George, Ronald B., et al. "A Randomized Trial of Phenylephrine Infusion Versus Bolus Dosing for Nausea and Vomiting During Cesarean Delivery in Obese Women." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 65, no. 3, 2018, pp. 254-262.
George RB, McKeen DM, Dominguez JE, et al. A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. Can J Anaesth. 2018;65(3):254-262.
George, R. B., McKeen, D. M., Dominguez, J. E., Allen, T. K., Doyle, P. A., & Habib, A. S. (2018). A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 65(3), 254-262. https://doi.org/10.1007/s12630-017-1034-6
George RB, et al. A Randomized Trial of Phenylephrine Infusion Versus Bolus Dosing for Nausea and Vomiting During Cesarean Delivery in Obese Women. Can J Anaesth. 2018;65(3):254-262. PubMed PMID: 29209926.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. AU - George,Ronald B, AU - McKeen,Dolores M, AU - Dominguez,Jennifer E, AU - Allen,Terrence K, AU - Doyle,Patricia A, AU - Habib,Ashraf S, Y1 - 2017/12/05/ PY - 2017/05/03/received PY - 2017/11/01/accepted PY - 2017/10/31/revised PY - 2017/12/7/pubmed PY - 2019/8/1/medline PY - 2017/12/7/entrez SP - 254 EP - 262 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 65 IS - 3 N2 - PURPOSE: Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. METHODS: In this multicentre, double-blinded randomized controlled trial, 160 obese women undergoing elective Cesarean delivery under spinal anesthesia were randomized to receive a prophylactic phenylephrine infusion initiated at 50 μg·min-1 (and titrated according to a predefined algorithm) or 100 μg phenylephrine boluses to treat hypotension. Maternal systolic blood pressure was maintained within 20% of baseline. The primary study outcome was the incidence of IONV. RESULTS: Intraoperative nausea and vomiting were significantly reduced in the infusion group compared to the bolus group (46% vs 75%, respectively; relative risk [RR], 0.61; 95% confidence interval [CI], 0.47 to 0.80; P < 0.001). This was associated with significantly reduced need for intraoperative rescue antiemetics (26% vs 42%, respectively; RR, 0.62; 95% CI, 0.40 to 0.97; P = 0.04), but no difference in the incidence of vomiting. Postoperative vomiting at two hours was reduced in the infusion group (11% vs 25%; RR, 0.44; 95% CI, 0.21 to 0.90; P = 0.02);however, there were no differences in the incidence or severity of postoperative nausea, need for rescue antiemetics at two hours and 24 hr, or the incidence of postoperative vomiting at 24 hr. CONCLUSION: In obese women undergoing Cesarean delivery with spinal anesthesia, prophylactic phenylephrine infusion was associated with less intraoperative nausea, less need for rescue antiemetics, and reduced early postoperative vomiting. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01481740). Registered 22 July 2011. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/29209926/A_randomized_trial_of_phenylephrine_infusion_versus_bolus_dosing_for_nausea_and_vomiting_during_Cesarean_delivery_in_obese_women_ L2 - https://dx.doi.org/10.1007/s12630-017-1034-6 DB - PRIME DP - Unbound Medicine ER -