title: Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section.
abstract: BACKGROUND
  Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy.
  
  
  METHODS
  Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.5 microg sufentanil, and 0.1 mg morphine. Maternal heart rate and systolic blood pressure were measured at frequent intervals. A vasopressor infusion was started immediately after spinal injection of either 2 mg/min ephedrine plus 10 microg/min phenylephrine or 2 mg/min ephedrine alone. Treatments were assigned randomly in a double-blind fashion. The infusion rate was adjusted according to systolic blood pressure using a predefined algorithm. Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with 6 mg ephedrine bolus doses.
  
  
  RESULTS
  Hypotension occurred less frequently in the ephedrine-phenylephrine group than in the ephedrine-alone group: 37% versus 75% (P = 0.02). Ephedrine (36+/-16 mg, mean +/- SD) plus 178+/-81 microg phenylephrine was infused in former group, whereas 54+/-18 mg ephedrine was infused in the latter. Median supplemental ephedrine requirements and nausea scores (0-3) were less in the ephedrine-phenylephrine group (0 vs. 12 mg, P = 0.02; and 0 vs. 1.5, P = 0.01, respectively). Umbilical artery pH values were significantly higher in the ephedrine-phenylephrine group than in the group that received ephedrine alone (7.24 vs. 7.19). Apgar scores were similarly good in both groups.
  
  
  CONCLUSIONS
  Phenylephrine added to an infusion of ephedrine halved the incidence of hypotension and increased umbilical cord pH.
authors.affiliation: Département d'Anesthésie-Réanimation, Hĵpital Antoine Béclère, Clamart France. frederic.mercier@abc.ap-hop-paris.fr
authors.forename: F J
authors.initials: FJ
authors.lastname: Mercier
authors.forename: E T
authors.initials: ET
authors.lastname: Riley
authors.forename: W L
authors.initials: WL
authors.lastname: Frederickson
authors.forename: S
authors.initials: S
authors.lastname: Roger-Christoph
authors.forename: D
authors.initials: D
authors.lastname: Benhamou
authors.forename: S E
authors.initials: SE
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004311:Double-Blind Method; D004809:Ephedrine / Q000008:administration & dosage*; D005260:Female; D005312:Fetal Blood / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007022:Hypotension / Q000517:prevention & control*; D010656:Phenylephrine / Q000008:administration & dosage*; D011247:Pregnancy
chemical_list: D010656:Phenylephrine; D004809:Ephedrine