| Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery. | |
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MedLine Citation:
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PMID: 19741494 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hemodynamic responses to vasopressors used during spinal anesthesia for elective Cesarean delivery, have not been well described. This study compared the effects of bolus phenylephrine and ephedrine on maternal cardiac output (CO). The hypothesis was that phenylephrine, but not ephedrine, decreases CO when administered in response to hypotension during spinal anesthesia. METHODS: Forty-three patients were randomized to receive 80 microg of phenylephrine or 10 mg of ephedrine. Both pulse wave form analysis and transthoracic bioimpedance changes were used to estimate stroke volume in each patient. Hemodynamic responses to spinal anesthesia and oxytocin were also recorded. A subgroup of 20 patients was randomized to receive oxytocin compared with oxytocin plus 80 microg of phenylephrine after delivery. RESULTS: Mean CO and maximum absolute response in CO were significantly lower during the 150 s after phenylephrine administration than after ephedrine (6.2 vs. 8.1 l/min, P = 0.001, and 5.2 vs. 9.0 l/min, P < 0.0001, respectively for pulse wave form analysis, and 5.2 vs. 6.3 l/min, P = 0.01 and 4.5 vs. 6.7 l/min, P = 0.0001, respectively for bioimpedance changes). CO changes correlated with heart rate changes. Coadministration of phenylephrine obtunded oxytocin-induced decreases in systemic vascular resistance and increases in heart rate and CO. Trends in CO change were similar using either monitor. CONCLUSIONS: Bolus phenylephrine reduced maternal CO, and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery. CO changes correlated with heart rate changes after vasopressor administration, emphasizing the importance of heart rate as a surrogate indicator of CO. Coadministered phenylephrine obtunded hemodynamic responses to oxytocin. |
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Authors:
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Robert A Dyer; Anthony R Reed; Dominique van Dyk; Michelle J Arcache; Owen Hodges; Carl J Lombard; Jaime Greenwood; Michael F James |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Anesthesiology Volume: 111 ISSN: 1528-1175 ISO Abbreviation: Anesthesiology Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-12-23 Completed Date: 2010-01-12 Revised Date: 2010-04-26 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: United States |
Other Details:
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Languages: eng Pagination: 753-65 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesia, University of Cape Town and New Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, South Africa. robert.dyer@uct.ac.za |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anesthesia, Obstetrical* Anesthesia, Spinal* Apgar Score Blood Pressure / drug effects Cardiac Output / drug effects Cardiography, Impedance Cesarean Section* Double-Blind Method Ephedrine / pharmacology* Female Hemodynamics / drug effects* Humans Infant, Newborn Monitoring, Intraoperative Oxytocin / pharmacology* Phenylephrine / pharmacology* Pregnancy Pregnancy Outcome Prospective Studies Treatment Outcome Vasoconstrictor Agents / pharmacology* |
| Chemical | |
Reg. No./Substance:
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0/Vasoconstrictor Agents; 299-42-3/Ephedrine; 50-56-6/Oxytocin; 59-42-7/Phenylephrine |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2010 May;112(5):1287-8; author reply 1288-94
[PMID:
20418708
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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