Effects of ephedrine and phenylephrine on uterine and placental circulations and fetal outcome following fetal hypoxaemia and epidural-induced hypotension in a sheep model.
BACKGROUND
Recent studies support the use of alpha-agonists during regional anaesthesia in uncomplicated term pregnancies. We hypothesized that ephedrine and phenylephrine, administered for maternal hypotension following fetal hypoxaemia, are equal in respect of fetal outcome.


METHODS
At 117-132 days gestation, chronically instrumented, anaesthetized and mechanically ventilated ewes were randomized to receive boluses of ephedrine (n=9) or phenylephrine (n=8) for maternal epidural-induced hypotension after a period of fetal hypoxaemia. Uterine (QUtA) and placental (QUA) volume blood flows were measured with perivascular transit-time ultrasonic flow probes, and uterine (RUtA) and placental (RUA) vascular resistances were computed from volume blood flows and maternal and fetal mean arterial pressures. Uterine (PIUtA) and umbilical artery (PIUA) pulsatility indices were obtained by Doppler ultrasonography.


RESULTS
Ephedrine increased QUtA and decreased RUtA and PIUtA from a hypotensive to baseline level and had no significant effect on umbilical circulation. With phenylephrine, QUtA remained lower (P=0.011) and RUtA higher (P=0.043) than at baseline, although PIUtA decreased to baseline level. PIUA increased from baseline with phenylephrine (P=0.007), whereas QUA decreased (P=0.050). Maternal volume expansion with hydroxyethyl starch decreased RUtA significantly irrespective of the vasopressor used. There were no significant differences in fetal blood gas values or lactate concentrations between the ephedrine and phenylephrine groups.


CONCLUSIONS
Despite the more favourable effects on uterine and placental circulations of ephedrine over phenylephrine, no significant differences in fetal acid-base status or lactate concentrations were observed.
Erkinaro
T
T
Department of Anaesthesiology, University Hospital of Oulu, PO Box 21, FIN-90029 OYS, Finland. tiina.erkinaro@pp.fimnet.fi
Mäkikallio
K
K
Kavasmaa
T
T
Alahuhta
S
S
Räsänen
J
J
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000818:Animals; D004809:Ephedrine / Q000627:therapeutic use*; D005260:Female; D005315:Fetal Diseases / Q000378:metabolism / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D000860:Hypoxia / Q000378:metabolism / Q000503:physiopathology; D019344:Lactic Acid / Q000097:blood; D010656:Phenylephrine / Q000627:therapeutic use*; D021041:Placental Circulation / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D011897:Random Allocation; D012039:Regional Blood Flow / Q000187:drug effects; D012756:Sheep; D014599:Uterus / Q000098:blood supply; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000316:Adrenergic alpha-Agonists; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D019344:Lactic Acid; D004809:Ephedrine