Maternal and Neonatal Effects of Vasopressors Used for Treating Hypotension after Spinal Anesthesia for Caesarean Section: A Randomized Controlled Study

Alma Soxhuku-Isufi; Vjollca Shpata; Hektor Sula

doi:10.3889/oamjms.2016.003

Authors

Alma Soxhuku-Isufi University Hospital of Obstetrics and Gynecology "KoÃ§o Gliozheni", Tirana
Vjollca Shpata Faculty of Technical Medical Sciences, University of Medicine in Tirana, Tirana
Hektor Sula Faculty Medicine, University of Medicine in Tirana, Tirana

DOI:

https://doi.org/10.3889/oamjms.2016.003

Keywords:

ephedrine, caesarean section, hypotension, maternal, neonatal outcome, phenylephrine

Abstract

AIM: The aim of the study was to examine whether ephedrine and phenylephrine were different in their efficacy for managing maternal hypotension and their effect of adverse maternal and neonatal outcome.

METHODS: A double-blind randomized controlled study in healthy pregnant women ASA physical status 2, which underwent elective caesarian delivery under spinal anesthesia. Patients were randomized to receive an intravenous bolus of either phenylephrine (Ph group) or ephedrine (E group) immediately after the episode of hypotension after spinal anesthesia. Maternal and neonatal outcomes were recorded.

RESULTS: Two hundred and two (202) pregnant women at term were entered in this study. There were no differences between group E and group Ph regarding the incidence of hypotension after vasopressor therapy, and the incidence of nausea and vomiting. There was no significant difference between groups in the first-minute and the 5th minute Apgar score, none of the neonates had the true fetal acidosis.

CONCLUSIONS: Ephedrine and phenylephrine have the same efficacy in treating hypotension after spinal anesthesia for caesarean section. The use of Phenylephrine was associated with better fetal acid-base status, and there were no differences on Apgar score values and on the incidence of maternal bradycardia and hypotension.

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References

Clark RB, Thompson DS, Thompson CH. Prevention of spinal hypotension associated with cesarean section. Anesthesiology. 1976;45:670â€“674.

http://dx.doi.org/10.1097/00000542-197612000-00018 DOI: https://doi.org/10.1097/00000542-197612000-00018

PMid:984486

Macarthur A, Riley ET. Obstetric anesthesia controversies: vasopressor choice for postspinal hypotension during cesarean delivery. Int Anesthesiol Clin. 2007;45:115â€“132.

http://dx.doi.org/10.1097/AIA.0b013e31802b8d53 DOI: https://doi.org/10.1097/AIA.0b013e31802b8d53

PMid:17215703

Rout C, Rocke DA. Spinal hypotension associated with cesarean section. Will preload ever work? Anesthesiology. 1999;91:1565-1567.

http://dx.doi.org/10.1097/00000542-199912000-00004 DOI: https://doi.org/10.1097/00000542-199912000-00004

PMid:10598594

Mercier FJ, Bonnet MP, De la Dorie A, Moufouki M, Banu F, Hanaf A, Edouard D, Roger-Christoph S. [Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension] Ann Fr Anesth Reanim. 2007;26:688â€“693.

http://dx.doi.org/10.1016/j.annfar.2007.05.003 DOI: https://doi.org/10.1016/j.annfar.2007.05.003

PMid:17590565

Reidy J, Douglas J. Vasopressors in obstetrics. Anesthesiol Clin. 2008;26:75-88.

http://dx.doi.org/10.1016/j.anclin.2007.11.005 DOI: https://doi.org/10.1016/j.anclin.2007.11.005

PMid:18319181

Cooper DW. Caesarean delivery vasopressor management. Current Opinion in Anesthesiology. 2012;25:300â€“308.

http://dx.doi.org/10.1097/ACO.0b013e3283530d62 DOI: https://doi.org/10.1097/ACO.0b013e3283530d62

PMid:22473212

KlÃ¶hr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: literature search and application to parturients. Acta Anaesthesiologica Scandinavica. 2010;54:909â€“921.

http://dx.doi.org/10.1111/j.1399-6576.2010.02239.x DOI: https://doi.org/10.1111/j.1399-6576.2010.02239.x

PMid:20455872

Lee A, Warwick D, Ngan WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002; 94:220-226.

http://dx.doi.org/10.1097/00000539-200204000-00028 DOI: https://doi.org/10.1097/00000539-200204000-00028

Alahuhta S, Rasanen J, Jouppila P, Hollmen AI. Ephedrine and phenylephrine for avoiding maternal hypotension due to spinal anaesthesia for caesarean section. Int J Obstet Anesth. 1992; 1:129-134.

http://dx.doi.org/10.1016/0959-289X(92)90016-W DOI: https://doi.org/10.1016/0959-289X(92)90016-W

Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section. Br J Anaesth. 1996; 76:61-65.

http://dx.doi.org/10.1093/bja/76.1.61 DOI: https://doi.org/10.1093/bja/76.1.61

PMid:8672382

Hall PA, Bennett A, Wilkes MP, Lewis M. Spinal anaesthesia for caesarean section: comparison of infusions of phenylephrine and ephedrine. Br J Anaesth. 1994;73:471â€“474.

http://dx.doi.org/10.1093/bja/73.4.471 DOI: https://doi.org/10.1093/bja/73.4.471

PMid:7999486

Moran DH, Perillo M, LaPorta RF, Bader AM, Datta S. Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth. 1991; 3:301-305.

http://dx.doi.org/10.1016/0952-8180(91)90224-B DOI: https://doi.org/10.1016/0952-8180(91)90224-B

Heesen M, KlÃ¶hr S, Rossaint R and Straube S. Prophylactic phenylephrine for caesarean section under spinal anaesthesia: systematic review and meta-analysis. Anaesthesia. 2014;69:143â€“165.

http://dx.doi.org/10.1111/anae.12445 DOI: https://doi.org/10.1111/anae.12445

PMid:24588024

Roberts SW, Leveno KJ, Sidawi JE, Lucas MJ, Kelly MA. Fetal acidemia associated with regional anesthesia for elective cesarean delivery. Obstet Gynecol. 1995;85:79-83.

http://dx.doi.org/10.1016/0029-7844(94)P4401-9 DOI: https://doi.org/10.1016/0029-7844(94)P4401-9

Lin FQ, Qiu MT, Xiang-Xiang Ding XX, Fu Sh K, Li Q. Ephedrine Versus Phenylephrine for the Management of Hypotension During Spinal Anesthesia for Cesarean Section: An Updated Meta-Analysis. CNS Neuroscience & Therapeutics. 2012;18:591â€“597.

http://dx.doi.org/10.1111/j.1755-5949.2012.00345.x DOI: https://doi.org/10.1111/j.1755-5949.2012.00345.x

PMid:22759268

Pierce ET, Carr DB, Datta S. Effects of ephedrine and phenylephrine on maternal and fetal atrial natriuretic peptide levels during elective cesarean section. Acta Anaesthesiol Scand. 1994; 38:48â€“51.

http://dx.doi.org/10.1111/j.1399-6576.1994.tb03836.x DOI: https://doi.org/10.1111/j.1399-6576.1994.tb03836.x

PMid:8140873

La Porta RF, Arthur GR, Datta S. Phenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations, acid base status and Apgar scores. Acta Anaesthesiol Scand. 1995;39: 901â€“905.

http://dx.doi.org/10.1111/j.1399-6576.1995.tb04195.x DOI: https://doi.org/10.1111/j.1399-6576.1995.tb04195.x

Mahajan L, Anand LK, Gombar KK. A randomized double-blinded comparison of ephedrine, phenylephrine and mephentermine infusions to maintain blood pressure during spinal anaesthesia for cesarean delivery: The effects on fetal acid-base status and haemodynamic control. J Anaesth Clin Pharmacol. 2009;25:427â€“432.

Ayorinde BT,Buczkowski P, Brown J, Shah J, Buggy DJ. Evaluation of pre-emptive intramuscular phenylephrine and ephedrine for reduction of spinal anaesthesia-induced hypotension during Caesarean section. Br J Anaesth. 2001; 86:372-376.

http://dx.doi.org/10.1093/bja/86.3.372 DOI: https://doi.org/10.1093/bja/86.3.372

PMid:11573527

Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Fetal and maternal effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2002;97:1582-1590.

http://dx.doi.org/10.1097/00000542-200212000-00034 DOI: https://doi.org/10.1097/00000542-200212000-00034

PMid:12459688

Allen TK, George RB, White WD, Muir HA, Habib AS. A double-blind, placebo-controlled trial of four fixed rate infusion regimens of phenylephrine for hemodynamic support during spinal anesthesia for cesarean delivery. Anesth Analg. 2010;111:1221â€“1229.

http://dx.doi.org/10.1213/ANE.0b013e3181e1db21 DOI: https://doi.org/10.1213/ANE.0b013e3181e1db21

PMid:20495139

Ngan Kee WD, Khaw KS, Tan PE, Ng FF, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009;111:506â€“512.

http://dx.doi.org/10.1097/ALN.0b013e3181b160a3 DOI: https://doi.org/10.1097/ALN.0b013e3181b160a3

PMid:19672175

Mueller MD, BrÃ¼hwiler H, SchÃ¼pfer GK, LÃ¼scher KP. Higher rate of fetal acidemia after regional anesthesia for elective cesarean delivery. Obstet Gynecol. 1997;90:131â€“134.

http://dx.doi.org/10.1016/S0029-7844(97)00210-X DOI: https://doi.org/10.1016/S0029-7844(97)00210-X

Kluger MT. Ephedrine may predispose to arrhythmias in obstetric anaesthesia. Anaesth Intensive Care. 2000;28:336. DOI: https://doi.org/10.1177/0310057X0002800331

PMid:10853227

Biddle C. To press or not to press, and if so, with what? A single question-focused meta analysis of vasopressor choice during regional anesthesia in obstetrics. AANA J. 2013;81:261-264.

PMid:24133847