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Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section.
Br J Anaesth 1996; 76(1):61-5BJ

Abstract

Thirty-eight healthy women undergoing elective Caesarean section under spinal anaesthesia at term were allocated randomly to receive boluses of either phenylephrine 100 micrograms or ephedrine 5 mg for maintenance of maternal arterial pressure. The indication for administration of vasopressor was a reduction in systolic pressure to < or = 90% of baseline values. Maternal arterial pressure (BP) and heart rate (HR) were measured every minute by automated oscillometry. Cardiac output (CO) was measured by cross-sectional and Doppler echocardiography before and after preloading with 1500 ml Ringer lactate solution and then every 2 min after administration of bupivacaine. Umbilical artery pulsatility index (PI) was measured using Doppler before and after spinal anaesthesia. The median (range) number of boluses of phenylephrine and ephedrine was similar; 6 (1-10) vs 4 (1-8) respectively. Maternal systolic BP and CO changes were similar in both groups, but the mean [95% CI] maximum percentage change in maternal HR was larger in the phenylephrine group (-28.5 [-24.2, -32.9]%) than in the ephedrine group (-14.4 [-10.6, -18.2]%). As a consequence atropine was required in 11/19 women in the phenylephrine group compared with 2/19 in the ephedrine group (P < 0.01). Mean umbilical artery pH [95% CI] was higher in the phenylephrine group (7.29 [7.28-7.30]) than in the ephedrine group (7.27 [7.25-7.28]). The results of the present study support the use of phenylephrine for maintenance of maternal arterial pressure during spinal anaesthesia for elective Caesarean section.

Authors+Show Affiliations

Department of Anaesthesia, Dryburn Hospital, Durham.

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8672382

Citation

Thomas, D G., et al. "Randomized Trial of Bolus Phenylephrine or Ephedrine for Maintenance of Arterial Pressure During Spinal Anaesthesia for Caesarean Section." British Journal of Anaesthesia, vol. 76, no. 1, 1996, pp. 61-5.
Thomas DG, Robson SC, Redfern N, et al. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 1996;76(1):61-5.
Thomas, D. G., Robson, S. C., Redfern, N., Hughes, D., & Boys, R. J. (1996). Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. British Journal of Anaesthesia, 76(1), pp. 61-5.
Thomas DG, et al. Randomized Trial of Bolus Phenylephrine or Ephedrine for Maintenance of Arterial Pressure During Spinal Anaesthesia for Caesarean Section. Br J Anaesth. 1996;76(1):61-5. PubMed PMID: 8672382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. AU - Thomas,D G, AU - Robson,S C, AU - Redfern,N, AU - Hughes,D, AU - Boys,R J, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - 61 EP - 5 JF - British journal of anaesthesia JO - Br J Anaesth VL - 76 IS - 1 N2 - Thirty-eight healthy women undergoing elective Caesarean section under spinal anaesthesia at term were allocated randomly to receive boluses of either phenylephrine 100 micrograms or ephedrine 5 mg for maintenance of maternal arterial pressure. The indication for administration of vasopressor was a reduction in systolic pressure to < or = 90% of baseline values. Maternal arterial pressure (BP) and heart rate (HR) were measured every minute by automated oscillometry. Cardiac output (CO) was measured by cross-sectional and Doppler echocardiography before and after preloading with 1500 ml Ringer lactate solution and then every 2 min after administration of bupivacaine. Umbilical artery pulsatility index (PI) was measured using Doppler before and after spinal anaesthesia. The median (range) number of boluses of phenylephrine and ephedrine was similar; 6 (1-10) vs 4 (1-8) respectively. Maternal systolic BP and CO changes were similar in both groups, but the mean [95% CI] maximum percentage change in maternal HR was larger in the phenylephrine group (-28.5 [-24.2, -32.9]%) than in the ephedrine group (-14.4 [-10.6, -18.2]%). As a consequence atropine was required in 11/19 women in the phenylephrine group compared with 2/19 in the ephedrine group (P < 0.01). Mean umbilical artery pH [95% CI] was higher in the phenylephrine group (7.29 [7.28-7.30]) than in the ephedrine group (7.27 [7.25-7.28]). The results of the present study support the use of phenylephrine for maintenance of maternal arterial pressure during spinal anaesthesia for elective Caesarean section. SN - 0007-0912 UR - https://www.unboundmedicine.com/medline/citation/8672382/Randomized_trial_of_bolus_phenylephrine_or_ephedrine_for_maintenance_of_arterial_pressure_during_spinal_anaesthesia_for_Caesarean_section_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)43941-9 DB - PRIME DP - Unbound Medicine ER -