Key result
A combination of phenylephrine and ephedrine effectively managed spinal-induced hypotension with minimal side effects, whereas phenylephrine alone resulted in bradycardia in 30% of patients.
Why the study?
Does a combination of ephedrine and phenylephrine improve blood pressure maintenance and foetal acid base status compared to either agent alone in parturients undergoing emergency caesarean section under spinal anaesthesia?
RCT (n=90)
Double-blind
randomized
Does a combination of ephedrine and phenylephrine improve blood pressure maintenance and foetal acid base status compared to either agent alone in parturients undergoing emergency caesarean section under spinal anaesthesia?
A combination of phenylephrine and ephedrine effectively prevents spinal-induced hypotension during caesarean section while minimizing maternal bradycardia and foetal acidosis compared to either agent alone.
Answers are grounded in this paper and cite their sources.
May inform vasopressor choice for spinal hypotension in caesarean; leaves open optimal regimen pending larger trials.
Introduction: Spinal anaesthesia is the preferred technique for caesarean section. Around 80% of which is complicated by maternal hypotension. Vasopressors are currently the treatment of choice for spinal-induced hypotension but these may individually have significant maternal or foetal side effects. Aim: To compare ephedrine and phenylephrine infusion with ephedrine and phenylephrine combination for preventing the hypotension in patients undergoing emergency caesarean section under spinal anaesthesia. Materials and Methods: A prospective randomized double blind study of 90 parturients beyond 32 weeks of pregnancy for caesarean section under spinal anaesthesia. Assuming a potency ratio of 80:1 ephedrine to phenylephrine, the patients were divided into the following three groups: Group E - received infusions of ephedrine 8 mg/ml, Group P - received infusions of 100 mcg/ml phenylephrine and Group E + P received infusion of ephedrine 4 mg/ml + phenylephrine 50 mcg/ml. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). After spinal injection, SBP, diastolic blood pressures (DBP), heart rate (HR) were recorded every one minute until the cord was clamped. Also, the vasopressor infusion rates were collected till clamping of umbilical cord in each group. Foetal parameters were analyzed from umbilical blood gas. Results: The incidence of hypotension was significantly higher in ephedrine group. The mean rate of infusion was higher for group E (P < 0.05). The foetal metabolism measured by mean pH, was significantly higher in group P(P > 0.05) as compared to others. Complications of bradycardia were observed in 30% of patients receiving phenylephrine. Conclusions: Combination of both phenylephrine and ephedrine is efficacious for spinal-induced hypotension with least maternal or foetal side effects.
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Verma et al. (2018) conducted an RCT in emergency caesarean section under spinal anaesthesia (n=90). Ephedrine and phenylephrine combination vs. Ephedrine alone (8 mg/ml) or phenylephrine alone (100 mcg/ml) was evaluated on Incidence of hypotension. A combination of phenylephrine and ephedrine effectively managed spinal-induced hypotension with minimal side effects, whereas phenylephrine alone resulted in bradycardia in 30% of patients.
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