A randomized trial comparing prophylactic phenylephrine and ephedrine infusion during spinal anesthesia for emergency cesarean delivery in cases of acute fetal compromise.
BACKGROUND
Previous evidence showed that use of phenylephrine was associated with higher umbilical artery pH (UA pH) than ephedrine after elective cesarean delivery (CD). However, the best choice of vasopressor and its effect on funic gases in cases of acute fetal compromise require additional studies.


METHODS
Ninety parturients showing acute fetal compromise during intrapartum period and taken up for CD (category II) under spinal anesthesia were randomized to receive prophylactic infusion of ephedrine 2.5mg/min or phenylephrine 30μg/min. Systolic blood pressure was targeted between 90% and 110% of baseline. Incidence of fetal acidosis (UA pH <7.2 and/or base deficit >12mmol/L) was recorded. Other parameters of cord gases, Apgar score, need for immediate resuscitation, maternal hemodynamics, and adverse events were also compared.


RESULTS
Number of neonates showing acidosis with ephedrine or phenylephrine was comparable (P=.22). Of these, newborns with base deficit >12mmol had low 1-minute Apgar scores (n=15/23). The ephedrine group had higher oxygen content in UA (P=.03). There was no adverse neonatal outcome during the period of observation. Incidence of maternal nausea and vomiting was higher with ephedrine than with phenylephrine (22.2% vs 4.4%; P=.02). Maternal bradycardia was observed with phenylephrine (P=.02).


CONCLUSIONS
Our data report similar fetal acidosis with either phenylephrine or ephedrine administered during spinal anesthesia for treating maternal hypotension in cases of emergency CD.
Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India. Electronic address: kajalteji@gmail.com.
Kajal
K
Jain
Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.
Jeetinder Kaur
JK
Makkar
Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.
Siva
S
Subramani Vp
Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.
Shalini
S
Gander
Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 1600012, India.
Praveen
P
Kumar
D000138:Acidosis / Q000139:chemically induced*; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D001034:Apgar Score; D001919:Bradycardia / Q000139:chemically induced; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D004630:Emergencies; D004809:Ephedrine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D005316:Fetal Distress / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005333:Fetus / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D007022:Hypotension / Q000517:prevention & control; D007231:Infant, Newborn; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D011247:Pregnancy; D011446:Prospective Studies; D012121:Respiration, Artificial; D014469:Umbilical Arteries / Q000737:chemistry; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D055815:Young Adult
D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004809:Ephedrine
Anesthesia; Cesarean; Emergency, category II; Ephedrine, phenylephrine; Spinal, vasopressor