Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomised study.
BACKGROUND
Maternal haemodynamic changes and neonatal well-being following bolus administration of ephedrine and phenylephrine were compared in 60 term parturients undergoing elective caesarean delivery under spinal anaesthesia.


METHODS
In a randomised double-blind study, women received boluses of either ephedrine 6 mg (group E; n=30) or phenylephrine 100 microg (group P; n=30) whenever maternal systolic pressure was 80% of baseline.


RESULTS
Changes in systolic pressure were comparable in the two groups. There were no differences in the incidence of bradycardia (group E: 0% vs. group P: 16.7%; P>0.05), nausea (group E: 13% vs. group: P 0; P>0.05) and vomiting (group E: 3.3% vs. group P: 0; P>0.05). Umbilical artery (UA) pH (group E: 7.29 +/- 0.04 vs. group P: 7.32 +/- 0.04; P=0.01) and venous pH (group E: 7.34 +/- 0.04 vs. group P: 7.38 +/- 0.05; P=0.002) were significantly greater in group P than in group E. UA base excess was significantly less in group E (-2.83 +/- 0.94 mEq/L) than in group P (-1.61 +/- 1.04 mEq/L; P<0.001). Apgar scores at 1, 5 and 10min and neurobehavioural scores at 2-4 h, 24 h and 48 h were similar in the two groups (P>0.05).


CONCLUSIONS
Phenylephrine 100 mug and ephedrine 6 mg had similar efficacy in the treatment of maternal hypotension during spinal anaesthesia for elective caesarean delivery. Neonates in group P had significantly higher umbilical arterial pH and base excess values than those in group E, which is consistent with other studies.
Prakash
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Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India. drsunilprakash@gmail.com
Pramanik
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V
Chellani
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Salhan
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Gogia
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AR
D000136:Acid-Base Equilibrium; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D001034:Apgar Score; D002585:Cesarean Section; D004311:Double-Blind Method; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology; D007231:Infant, Newborn; D008787:Metoclopramide / Q000627:therapeutic use; D010147:Pain Measurement; D010656:Phenylephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011247:Pregnancy; D011899:Ranitidine / Q000627:therapeutic use; D018401:Sample Size; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D000897:Anti-Ulcer Agents; D000932:Antiemetics; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D011899:Ranitidine; D004809:Ephedrine; D008787:Metoclopramide