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Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise: a randomised controlled study.
Int J Obstet Anesth. 2022 Feb; 49:103247.IJ

Abstract

BACKGROUND

Norepinephrine is as effective as phenylephrine for management of spinal anaesthesia-induced hypotension. Most of the studies comparing these vasopressors have been conducted in healthy pregnant women undergoing elective caesarean section. In the current study, we tested the null hypothesis that there is no difference in neonatal outcome when phenylephrine or norepinephrine is used to treat spinal anaesthesia-induced hypotension in women undergoing emergency caesarean section for fetal compromise.

METHODS

Patients undergoing caesarean section for fetal compromise who developed spinal anaesthesia-induced hypotension were randomised to receive phenylephrine 100 μg or norepinephrine 8 μg for treatment of each hypotensive episode, defined as systolic blood pressure <100 mmHg. Umbilical cord arterial and venous blood samples were obtained for blood gas analysis. The primary outcome measure was umbilical artery pH.

RESULTS

One hundred patients (50 in each group) were studied. There was no significant difference in umbilical artery pH between the two groups (mean difference 0.001; 95% CI -0.032 to 0.034). The number of hypotensive episodes, vasopressor boluses required, the incidence of bradycardia, heart rate and blood pressure trends following vasopressor administration, and the incidence of nausea/vomiting were not significantly different between groups.

CONCLUSION

Phenylephrine 100 μg and norepinephrine 8 μg were not significantly different in terms of neonatal outcome when administered as intravenous boluses for treatment of spinal anaesthesia-induced hypotension in parturients undergoing emergency caesarean sections for fetal compromise.

Authors+Show Affiliations

Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. Electronic address: medhamohta@gmail.com.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 Obstetrics and Gynaecology, 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.Department of Paediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

35012812

Citation

Mohta, M, et al. "Neonatal Outcomes Following Phenylephrine or Norepinephrine for Treatment of Spinal Anaesthesia-induced Hypotension at Emergency Caesarean Section in Women With Fetal Compromise: a Randomised Controlled Study." International Journal of Obstetric Anesthesia, vol. 49, 2022, p. 103247.
Mohta M, Bambode N, Chilkoti GT, et al. Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise: a randomised controlled study. Int J Obstet Anesth. 2022;49:103247.
Mohta, M., Bambode, N., Chilkoti, G. T., Agarwal, R., Malhotra, R. K., & Batra, P. (2022). Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise: a randomised controlled study. International Journal of Obstetric Anesthesia, 49, 103247. https://doi.org/10.1016/j.ijoa.2021.103247
Mohta M, et al. Neonatal Outcomes Following Phenylephrine or Norepinephrine for Treatment of Spinal Anaesthesia-induced Hypotension at Emergency Caesarean Section in Women With Fetal Compromise: a Randomised Controlled Study. Int J Obstet Anesth. 2022;49:103247. PubMed PMID: 35012812.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neonatal outcomes following phenylephrine or norepinephrine for treatment of spinal anaesthesia-induced hypotension at emergency caesarean section in women with fetal compromise: a randomised controlled study. AU - Mohta,M, AU - Bambode,N, AU - Chilkoti,G T, AU - Agarwal,R, AU - Malhotra,R K, AU - Batra,P, Y1 - 2021/12/17/ PY - 2021/03/31/received PY - 2021/10/24/revised PY - 2021/12/12/accepted PY - 2022/1/12/pubmed PY - 2022/3/19/medline PY - 2022/1/11/entrez KW - Caesarean section KW - Fetal compromise KW - Neuraxial anaesthesia KW - Norepinephrine KW - Phenylephrine KW - Spinal hypotension, treatment SP - 103247 EP - 103247 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 49 N2 - BACKGROUND: Norepinephrine is as effective as phenylephrine for management of spinal anaesthesia-induced hypotension. Most of the studies comparing these vasopressors have been conducted in healthy pregnant women undergoing elective caesarean section. In the current study, we tested the null hypothesis that there is no difference in neonatal outcome when phenylephrine or norepinephrine is used to treat spinal anaesthesia-induced hypotension in women undergoing emergency caesarean section for fetal compromise. METHODS: Patients undergoing caesarean section for fetal compromise who developed spinal anaesthesia-induced hypotension were randomised to receive phenylephrine 100 μg or norepinephrine 8 μg for treatment of each hypotensive episode, defined as systolic blood pressure <100 mmHg. Umbilical cord arterial and venous blood samples were obtained for blood gas analysis. The primary outcome measure was umbilical artery pH. RESULTS: One hundred patients (50 in each group) were studied. There was no significant difference in umbilical artery pH between the two groups (mean difference 0.001; 95% CI -0.032 to 0.034). The number of hypotensive episodes, vasopressor boluses required, the incidence of bradycardia, heart rate and blood pressure trends following vasopressor administration, and the incidence of nausea/vomiting were not significantly different between groups. CONCLUSION: Phenylephrine 100 μg and norepinephrine 8 μg were not significantly different in terms of neonatal outcome when administered as intravenous boluses for treatment of spinal anaesthesia-induced hypotension in parturients undergoing emergency caesarean sections for fetal compromise. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/35012812/Neonatal_outcomes_following_phenylephrine_or_norepinephrine_for_treatment_of_spinal_anaesthesia_induced_hypotension_at_emergency_caesarean_section_in_women_with_fetal_compromise:_a_randomised_controlled_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(21)00305-8 DB - PRIME DP - Unbound Medicine ER -