Key result
Phenylephrine better maintained maternal blood pressure and resulted in higher umbilical artery blood pH compared to ephedrine, though 23.33% required atropine for bradycardia.
Why the study?
Previous comparisons of ephedrine and phenylephrine for hypotension during elective cesarean section yielded conflicting conclusions, and none had evaluated these agents in North-Eastern India.
Does phenylephrine improve maternal blood pressure maintenance and umbilical artery pH compared to ephedrine in pregnant patients undergoing caesarean section under spinal anaesthesia?
Does phenylephrine improve maternal blood pressure maintenance and umbilical artery pH compared to ephedrine in pregnant patients undergoing caesarean section under spinal anaesthesia?
Phenylephrine provides better maintenance of maternal blood pressure and higher umbilical artery pH than ephedrine during spinal anesthesia for cesarean section, despite a higher incidence of bradycardia.
Answers are grounded in this paper and cite their sources.
May support phenylephrine preference in obstetric anesthesia with bradycardia monitoring; hypothesis-generating and should not change practice without larger trials.
BACKGROUND vasopressor drug is often required to control hypotension. Many authors have compared ephedrine and phenylephrine as in patients undergoing elective cesarean section with conflicting conclusions, but none have evaluated these two in patients from the North-Eastern part of India. As a secondary objective, we intended to evaluate the side effects and artery blood pH (UApH). AND METHODS parturients of ASA-I and ASA-II category, in the age group of 20-30 years, with weight of 50-70 kg and height of 150- 170 cms posted for elective caesarean section under spinal anaesthesia were selected for the study. After dural puncture with 23G spinal needle, 2.5 ml of 0.5% bupivacaine heavy was injected. Systolic and diastolic blood pressures (SBP and DBP) were after subarachnoid block, and then every 2 mins for next 20 mins and thereafter every 5 mins till 30 minutes. Whenever SBP falls below 20% of the baseline value, the study drug was given. Rescue atropine sulphate (0.3 mg IV) was given when heart rate became less than 50. number of boluses of phenylephrine(Group-P) required to maintain maternal blood pressure were less as compared to (Group- E) in the first 6 minutes. In Group-P, 23.33% patients required single dose of Atropine to treat bradycardia 76.67% patients did not require any atropine dose. In Group- E, no patients required any rescue dose of Atropine. Higher in Group-P (Mean 7.37±0.023) as compared to Group-E (7.319±0.021) was noticed. maternal blood pressure was better maintained with phenylephrine as compared to ephedrine. There was less maternal rate along with statistically significant higher UApH in the patients receiving phenylephrine.
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Lahkar et al. (2019) studied Hypotension during elective caesarean section under spinal anaesthesia. Phenylephrine vs. Ephedrine was evaluated on Umbilical artery blood pH (UApH). Phenylephrine better maintained maternal blood pressure and resulted in higher umbilical artery blood pH compared to ephedrine, though 23.33% required atropine for bradycardia.
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