| A randomized double-blinded comparison of phenylephrine and ephedrine infusion combinations to maintain blood pressure during spinal anesthesia for cesarean delivery: the effects on fetal acid-base status and hemodynamic control. | |
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MedLine Citation:
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PMID: 18806043 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Phenylephrine and ephedrine are both used to maintain arterial blood pressure during spinal anesthesia for cesarean delivery. Usually, either drug is given alone but several previous studies have described combining the drugs. However, the effect of varying the proportion of vasopressors in such combinations has not been reported. METHODS: One-hundred-twenty-five parturients having spinal anesthesia for elective cesarean delivery were randomized to receive an IV infusion of phenylephrine and ephedrine combined in one of five different concentration ratios. Assuming phenylephrine 100 microg to be approximately equipotent to ephedrine 8 mg, the groups contained the proportional potency equivalent of 100%, 75%, 50%, 25% or 0% of phenylephrine and 0%, 25%, 50%, 75% or 100%, respectively, of ephedrine. The infusions were adjusted to maintain systolic blood pressure (SBP) near baseline until uterine incision. Hemodynamic changes and umbilical cord blood gases were compared. RESULTS: As the proportion of phenylephrine decreased and proportion of ephedrine increased among the groups, the following significant trends were detected: the incidences of hypotension and nausea/vomiting increased, the median magnitude of deviations of SBP above or below baseline and the bias for SBP to be above baseline increased, maternal heart rate was faster, fetal pH and base excess decreased, umbilical arterial oxygen content decreased and umbilical venous Po2 increased. CONCLUSIONS: When varying combinations of phenylephrine and ephedrine were given by infusion to maintain arterial blood pressure during spinal anesthesia for cesarean delivery, as the proportion of phenylephrine decreased and the proportion of ephedrine increased, hemodynamic control was reduced and fetal acid-base status was less favorable. Combinations of phenylephrine and ephedrine appear to have no advantage compared with phenylephrine alone when administered by infusion for the prevention of hypotension associated with spinal anesthesia for cesarean delivery. |
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Authors:
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Warwick D Ngan Kee; Anna Lee; Kim S Khaw; Floria F Ng; Manoj K Karmakar; Tony Gin |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 107 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2008 Oct |
Date Detail:
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Created Date: 2008-09-22 Completed Date: 2008-10-09 Revised Date: 2008-11-28 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 1295-302 Citation Subset: AIM; IM |
Affiliation:
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Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. warwick@cuhk.edu.h |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acid-Base Equilibrium
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drug effects Adult Anesthesia, Obstetrical* Anesthesia, Spinal* Blood Pressure / drug effects* Carbon Dioxide / blood Cesarean Section* Double-Blind Method Drug Combinations Ephedrine / administration & dosage*, adverse effects, pharmacology Female Fetal Blood / chemistry Fetus / drug effects*, metabolism Heart Rate / drug effects Hemoglobins / analysis Humans Hypotension / chemically induced Infusions, Intravenous Oxygen / blood Phenylephrine / administration & dosage*, adverse effects, pharmacology Postoperative Nausea and Vomiting / etiology Pregnancy Vasoconstrictor Agents / administration & dosage*, pharmacology |
| Chemical | |
Reg. No./Substance:
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0/Drug Combinations; 0/Hemoglobins; 0/Vasoconstrictor Agents; 124-38-9/Carbon Dioxide; 299-42-3/Ephedrine; 59-42-7/Phenylephrine; 7782-44-7/Oxygen |
| Comments/Corrections | |
Erratum In:
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Anesth Analg. 2008 Dec;107(6):2078 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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