title: Prophylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension During Cesarean Delivery in a Resource-Constrained Environment.
abstract: Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure <70% baseline or systolic blood pressure <80 mm Hg). Fewer patients receiving prophylactic phenylephrine infusions had severe hypotension (47.4% [n = 120/253] vs 62.1% [n = 157/253], P = .001, estimated relative risk 0.84, 95% confidence interval, 0.69-1.02), with no significant difference in the rate of hypertension (15% [n = 39/253] vs 11% [n = 27/253], P = .11, estimated relative risk 1.39, confidence interval 0.87-2.20). Guidelines for resource-constrained settings should consider a fixed, low-dose phenylephrine infusion in combination with rescue vasopressor bolus therapy.
authors.affiliation: From the *Perioperative Research Group, Metropolitan Department of Anaesthetics, Critical Care and Pain Management, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa; and †Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David G
authors.initials: DG
authors.lastname: Bishop
authors.forename: Carel
authors.initials: C
authors.lastname: Cairns
authors.forename: Mariette
authors.initials: M
authors.lastname: Grobbelaar
authors.forename: Reitze N
authors.initials: RN
authors.lastname: Rodseth
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006295:Health Resources; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000453:epidemiology; D007262:Infusions, Intravenous; D010656:Phenylephrine / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine