British Journal of Anaesthesia, Vol 76, Issue 1 61-65, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
D. G. Thomas, S. C. Robson, N. Redfern, D. Hughes and R. J. Boys
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.
CLINICAL INVESTIGATIONS
Randomized trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for Caesarean section
Department of Anaesthesia, Dryburn Hospital, Durham; Department of Obstetrics and Gynaecology, University of Newcastle-upon-Tyne; Department of Anaesthesia, RVI, Newcastle-upon-Tyne; Department of Statistics, Univesity of Newcastle-upon-Tyne
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