Tags

Type your tag names separated by a space and hit enter

Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia: A randomized controlled trial.
Int J Surg. 2019 Feb; 62:5-11.IJ

Abstract

BACKGROUND

Phenylephrine is the first-line vasoactive drug in the cesarean section under spinal anesthesia. The rate of hypotension remains high after intravenous preventive use of phenylephrine. However, few studies have investigated the effect of preventive intramuscular phenylephrine via a longer period of usage on fetal and maternal outcomes.

METHODS

A total of 99 healthy parturients undergoing elective cesarean delivery were randomly allocated into three groups: M group (preventive intramuscular use of 5 mg phenylephrine), V group (preventive intravenous use of 100 μg phenylephrine), and P group (0.9% normal saline placebo). Rescue phenylephrine, ephedrine and atropine were used intraoperatively to adjust blood pressure and heart rate. The primary outcome was umbilical artery pH.

RESULTS

Significant differences in umbilical artery pH (M group: 7.32 ± 0.05 versus V group: 7.25 ± 0.04 versus P group: 7.21 ± 0.03, P < 0.05), fetal acidosis (M group: 3% [n = 33] versus V group: 15% [n = 33] versus P group: 30% [n = 33], P = 0.01) and maternal intraoperative hypotension (M group: 12% [33] versus V group: 39% [33] versus P group: 73% [33], P < 0.0001) were identified among the groups. Multiple linear regression analysis demonstrated that treating arms, neonatal birthweight and the interval from the end of anesthesia to baby delivery were associated with umbilical artery pH.

CONCLUSION

Compared with the preventive intravenous use of phenylephrine and placebo, preventive intramuscular phenylephrine exhibited a better neonatal acid-base status and more stable maternal hemodynamics in elective cesarean under spinal anesthesia.

Authors+Show Affiliations

Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China.Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan, Xuzhou, Jangsu, China; Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical, University, No.99 Huaihai West Road, Xuzhou, Jangsu, China. Electronic address: qdy0828@163.com.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30639574

Citation

Xu, Chao, et al. "Preventive Intramuscular Phenylephrine in Elective Cesarean Section Under Spinal Anesthesia: a Randomized Controlled Trial." International Journal of Surgery (London, England), vol. 62, 2019, pp. 5-11.
Xu C, Liu S, Qian D, et al. Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia: A randomized controlled trial. Int J Surg. 2019;62:5-11.
Xu, C., Liu, S., Qian, D., Liu, A., Liu, C., Chen, Y., & Qi, D. (2019). Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia: A randomized controlled trial. International Journal of Surgery (London, England), 62, 5-11. https://doi.org/10.1016/j.ijsu.2018.12.014
Xu C, et al. Preventive Intramuscular Phenylephrine in Elective Cesarean Section Under Spinal Anesthesia: a Randomized Controlled Trial. Int J Surg. 2019;62:5-11. PubMed PMID: 30639574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventive intramuscular phenylephrine in elective cesarean section under spinal anesthesia: A randomized controlled trial. AU - Xu,Chao, AU - Liu,Su, AU - Qian,Dongchen, AU - Liu,Aohua, AU - Liu,Chang, AU - Chen,Yajie, AU - Qi,Dunyi, Y1 - 2019/01/11/ PY - 2018/10/26/received PY - 2018/12/02/revised PY - 2018/12/20/accepted PY - 2019/1/15/pubmed PY - 2019/4/23/medline PY - 2019/1/15/entrez KW - Cesarean section KW - Intramuscular injection KW - Phenylephrine KW - Spinal anesthesia SP - 5 EP - 11 JF - International journal of surgery (London, England) JO - Int J Surg VL - 62 N2 - BACKGROUND: Phenylephrine is the first-line vasoactive drug in the cesarean section under spinal anesthesia. The rate of hypotension remains high after intravenous preventive use of phenylephrine. However, few studies have investigated the effect of preventive intramuscular phenylephrine via a longer period of usage on fetal and maternal outcomes. METHODS: A total of 99 healthy parturients undergoing elective cesarean delivery were randomly allocated into three groups: M group (preventive intramuscular use of 5 mg phenylephrine), V group (preventive intravenous use of 100 μg phenylephrine), and P group (0.9% normal saline placebo). Rescue phenylephrine, ephedrine and atropine were used intraoperatively to adjust blood pressure and heart rate. The primary outcome was umbilical artery pH. RESULTS: Significant differences in umbilical artery pH (M group: 7.32 ± 0.05 versus V group: 7.25 ± 0.04 versus P group: 7.21 ± 0.03, P < 0.05), fetal acidosis (M group: 3% [n = 33] versus V group: 15% [n = 33] versus P group: 30% [n = 33], P = 0.01) and maternal intraoperative hypotension (M group: 12% [33] versus V group: 39% [33] versus P group: 73% [33], P < 0.0001) were identified among the groups. Multiple linear regression analysis demonstrated that treating arms, neonatal birthweight and the interval from the end of anesthesia to baby delivery were associated with umbilical artery pH. CONCLUSION: Compared with the preventive intravenous use of phenylephrine and placebo, preventive intramuscular phenylephrine exhibited a better neonatal acid-base status and more stable maternal hemodynamics in elective cesarean under spinal anesthesia. SN - 1743-9159 UR - https://www.unboundmedicine.com/medline/citation/30639574/Preventive_intramuscular_phenylephrine_in_elective_cesarean_section_under_spinal_anesthesia:_A_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-9191(19)30005-6 DB - PRIME DP - Unbound Medicine ER -