title: A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia.
abstract: Phenylephrine is effective for the management of spinal anesthesia-induced hypotension in parturients undergoing cesarean delivery under spinal anesthesia. While ephedrine was previously considered the vasopressor of choice in obstetric patients, phenylephrine is increasingly being used. This is largely due to studies suggesting improved fetal acid-base status with the use of phenylephrine as well as the low incidence of hypotension and its related side effects with prophylactic phenylephrine regimens. This review highlights the effects of phenylephrine compared with ephedrine on maternal hemodynamics (arterial blood pressure, heart rate, and cardiac output), and occurrence of intraoperative nausea and vomiting. The impact of the administration of phenylephrine as a bolus for the treatment of established hypotension compared with its administration as a prophylactic infusion is discussed. This article also reviews the impact of phenylephrine compared with ephedrine on uteroplacental perfusion, and fetal outcomes such as neonatal acid-base status and Apgar scores. The optimum dosing regimen for phenylephrine administration is also discussed.
authors: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. habib001@mc.duke.edu
authors: Ashraf S
authors: AS
authors: Habib
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001034:Apgar Score; D002585:Cesarean Section; D004809:Ephedrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007231:Infant, Newborn; D010656:Phenylephrine / Q000008:administration & dosage* / Q000009:adverse effects; D021041:Placental Circulation / Q000187:drug effects; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004809:Ephedrine