Document Detail


Hemodynamic effects of ephedrine, phenylephrine, and the coadministration of phenylephrine with oxytocin during spinal anesthesia for elective cesarean delivery.
MedLine Citation:
PMID:  19741494     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  111     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-12-23     Completed Date:  2010-01-12     Revised Date:  2010-04-26    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  753-65     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesia, University of Cape Town and New Groote Schuur Hospital, Anzio Road, Observatory, Cape Town, South Africa. robert.dyer@uct.ac.za
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MeSH Terms
Descriptor/Qualifier:
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:
0/Vasoconstrictor Agents; 299-42-3/Ephedrine; 50-56-6/Oxytocin; 59-42-7/Phenylephrine
Comments/Corrections
Comment In:
Anesthesiology. 2010 May;112(5):1287-8; author reply 1288-94   [PMID:  20418708 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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