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A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section.
Anaesthesia. 2019 Jul; 74(7):850-855.A

Abstract

Phenylephrine is currently the vasopressor of choice during elective caesarean section, but it can cause reflex bradycardia. Noradrenaline, a potent α-agonist and weak β-agonist, may be associated with a lower incidence of bradycardia. However, comparative information is limited. This double-blind randomised controlled trial compared the effects of 100 μg phenylephrine and 5 μg noradrenaline administered as boluses for the treatment of postspinal hypotension during elective caesarean section in women with an uncomplicated singleton pregnancy. Hypotension was defined as a decrease of ≥ 20% from baseline systolic arterial pressure, or an absolute value < 100 mmHg. Ninety women were included in the study. The primary outcome was the incidence of maternal bradycardia < 60 beats.min-1 . There was no difference in the incidence of bradycardia (37.8% with phenylephrine vs. 22.2% with noradrenaline; p = 0.167), number of hypotensive episodes, number of boluses required to treat the first hypotensive episode or reactive hypertension. The total number of boluses used was higher in the phenylephrine group (p = 0.01). Maternal heart rate at 1 min after vasopressor administration was non-significantly lower using phenylephrine vs. noradrenaline (p = 0.034, considering p < 0.01 as statistically significant). The umbilical artery pH was higher using phenylephrine than with noradrenaline (p = 0.034). In conclusion, both vasopressors reversed postspinal hypotension without a statistically significant difference in maternal bradycardia. However, in view of the lower umbilical artery pH when using noradrenaline, further research is warranted to study its placental transfer and fetal metabolic effects.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.Delhi Cancer Registry, Dr. BRA IRCH, All India Institute of Medical Sciences, Delhi, India.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31044424

Citation

Mohta, M, et al. "A Randomised Controlled Trial of Phenylephrine and Noradrenaline Boluses for Treatment of Postspinal Hypotension During Elective Caesarean Section." Anaesthesia, vol. 74, no. 7, 2019, pp. 850-855.
Mohta M, Garg A, Chilkoti GT, et al. A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section. Anaesthesia. 2019;74(7):850-855.
Mohta, M., Garg, A., Chilkoti, G. T., & Malhotra, R. K. (2019). A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section. Anaesthesia, 74(7), 850-855. https://doi.org/10.1111/anae.14675
Mohta M, et al. A Randomised Controlled Trial of Phenylephrine and Noradrenaline Boluses for Treatment of Postspinal Hypotension During Elective Caesarean Section. Anaesthesia. 2019;74(7):850-855. PubMed PMID: 31044424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomised controlled trial of phenylephrine and noradrenaline boluses for treatment of postspinal hypotension during elective caesarean section. AU - Mohta,M, AU - Garg,A, AU - Chilkoti,G T, AU - Malhotra,R K, Y1 - 2019/05/01/ PY - 2019/03/28/accepted PY - 2019/5/3/pubmed PY - 2019/6/25/medline PY - 2019/5/3/entrez KW - alpha-agonist KW - anaesthesia; spinal KW - blood pressure KW - caesarean section KW - hypotension, treatment KW - noradrenaline KW - phenylephrine SP - 850 EP - 855 JF - Anaesthesia JO - Anaesthesia VL - 74 IS - 7 N2 - Phenylephrine is currently the vasopressor of choice during elective caesarean section, but it can cause reflex bradycardia. Noradrenaline, a potent α-agonist and weak β-agonist, may be associated with a lower incidence of bradycardia. However, comparative information is limited. This double-blind randomised controlled trial compared the effects of 100 μg phenylephrine and 5 μg noradrenaline administered as boluses for the treatment of postspinal hypotension during elective caesarean section in women with an uncomplicated singleton pregnancy. Hypotension was defined as a decrease of ≥ 20% from baseline systolic arterial pressure, or an absolute value < 100 mmHg. Ninety women were included in the study. The primary outcome was the incidence of maternal bradycardia < 60 beats.min-1 . There was no difference in the incidence of bradycardia (37.8% with phenylephrine vs. 22.2% with noradrenaline; p = 0.167), number of hypotensive episodes, number of boluses required to treat the first hypotensive episode or reactive hypertension. The total number of boluses used was higher in the phenylephrine group (p = 0.01). Maternal heart rate at 1 min after vasopressor administration was non-significantly lower using phenylephrine vs. noradrenaline (p = 0.034, considering p < 0.01 as statistically significant). The umbilical artery pH was higher using phenylephrine than with noradrenaline (p = 0.034). In conclusion, both vasopressors reversed postspinal hypotension without a statistically significant difference in maternal bradycardia. However, in view of the lower umbilical artery pH when using noradrenaline, further research is warranted to study its placental transfer and fetal metabolic effects. SN - 1365-2044 UR - https://www.unboundmedicine.com/medline/citation/31044424/A_randomised_controlled_trial_of_phenylephrine_and_noradrenaline_boluses_for_treatment_of_postspinal_hypotension_during_elective_caesarean_section_ L2 - https://doi.org/10.1111/anae.14675 DB - PRIME DP - Unbound Medicine ER -