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BJA Advance Access published online on December 23, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei305
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted November 1, 2005

Laboratory Investigation

Ephedrine and phenylephrine for the treatment of maternal hypotension in a chronic sheep model of increased placental vascular resistance{dagger}

T. Erkinaro 1 *, T. Kavasmaa 1, M. Päkkilä 2, G. Acharya 3, K. Mäkikallio 2, S. Alahuhta 1, and J. Räsänen 2

1 Department of Anaesthesiology, Oulu University Hospital, PO Box 21, FIN-90029 OYS, Finland
2 Department of Obstetrics and Gynaecology, Oulu University Hospital, PO Box 21, FIN-90029 OYS, Finland
3 Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, N-9038 Tromsø, Norway

* To whom correspondence should be addressed.
T. Erkinaro, E-mail: tiina.erkinaro{at}pp.fimnet.fi


  Abstract

Background. We hypothesized that ephedrine and phenylephrine are equal with respect to uterine and placental haemodynamics and fetal acid-base status after exposure to maternal hypoxaemia and hypotension in a chronic sheep model of increased placental vascular resistance (RUA).

Methods. At 114-135 days gestation, chronically instrumented fetal sheep underwent placental embolization leading to increased RUA. Twenty-four hours after embolization, the ewes were anaesthetized and randomized to receive boluses of ephedrine (n=7) or phenylephrine (n=6) for epidural-induced hypotension after maternal hypoxaemia. Uterine (QUtA) and placental (QUA) volume blood flows and uterine vascular resistance (RUtA) and RUA were recorded. Uterine (PIUtA) and umbilical artery (PIUA) pulsatility indices were obtained by Doppler ultrasonography. Fetal arterial blood samples were analysed for acid-base values and lactate concentrations.

Results. During hypotension, QUtA, fetal pH, BE, and PO2 decreased whereas RUtA, PIUtA, RUA, and fetal lactate concentration increased. With ephedrine, QUtA, RUtA, PIUtA, RUA, and fetal PO2 returned to baseline. Fetal pH, BE, and lactate concentration did not change from hypotensive values. With phenylephrine, QUtA remained lower (P=0.007) and RUtA (P=0.007), PIUtA (P=0.013), and RUA (P=0.050) higher than at baseline. Fetal PO2 returned to baseline and fetal pH and BE did not change from hypotensive values. However, fetal lactate concentration increased further (mean difference 1.49, 95% confidence interval 0.72-2.26 mmol litre-1; P=0.004).

Conclusions. In a chronic sheep model of increased placental vascular resistance, compared with ephedrine administration, phenylephrine administration was associated with impaired uterine and placental haemodynamics and increased fetal lactate concentrations.

Keywords: anaesthesia, obstetric; anaesthetic techniques, epidural; sympathetic nervous system, pharmacology, ephedrine; sympathetic nervous system, pharmacology, phenylephrine.
{dagger}Presented in part at the Euroanaesthesia 2005 Meeting, Vienna, Austria, May 28-31, 2005.
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This article has been cited by other articles:


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Ephedrine and phenylephrine for treatment of maternal hypotension.
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Phenylephrine is still the drug of choice for pregnant humans.
Edward T. Riley
British Journal of Anaesthesia, 2 Mar 2006 [Full text]
Ephedrine and phenylephrine for the treatment of maternal hypotension in a chronic sheep model of i
Tiina Erkinaro, et al.
British Journal of Anaesthesia, 3 Mar 2006 [Full text]

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