Abstract
Background: Anaesthesia to a parturient is not only unique but also requires highest degree of care because the anaesthesiologist has to look after two individuals, the mother and fœtus. Hypotension during spinal anaesthesia for caesarean delivery can have detrimental effects on both mother and neonate. These effects include decreased utero-placental blood flow, impaired foetal oxygenation with asphyxial stress and foetal acidosis and maternal symptoms of low cardiacoutput such as nausea, vomiting, dizziness and decreased consciousness. Vasopressor like Ephedrine, Mephentermine, Phenylephrine, are used for treating the hypotension. In this study we compared the efficacy of Ephedrine, Mephentermine and Phenylephrine in treating the hypotension for caesarean section and their desirable side effects. Materials and Methods: In this prospective randomised controlled study, 90 patients of ASA physical status I and II belonging to age group of 18-35 years undergoing elective or emergency LSCS under sub-arachnoid block were randomly allocated into 3 groups of 30patients each, Group E (Ephedrine) and Group M (Mephentermine) and Group P (Phenyephrine). Group E received Inj Ephedrine 6 mg IV bolus, Group M received Inj Mephentermine 6 mg IV bolus and Group P received Inj Phenylephrine 100 microgram IV bolus for spinal anaesthesia. The changes in hemodynamic parameters, neonatal outcome, side-effects and usage of rescue vasopressor were compared between the groups. Results: The mean age in group P was 24.2 years, in group E 25.7 years and in group M was 25.7 years, which was similar across the groups. The time between induction and delivery was 87.8 sec in group P, 89.4 sec in group E and 89.6 sec in group M. The time at which 1st vasopressor dose given was 5.2 min in group P, 4.8 min in group E and 4.87 min in group M. The mean heart rate was lower in group P at all the points of study after episode of hypotension. The bolus drug requirement was highest in group P with mean of 3.52 followed by group M with mean of 2.86 and group E with mean of 2.55. The group E required rescue analgesia 73% of time, group M 70% of time and group P also 70% of time in study. The mean APGAR score at 1 minute was 8.2 in group P, 8.4 in group E and 8.6 in group M. Conclusion: During subarachnoid block for cesarean delivery, all three of the study's vasopressors— phenylephrine, ephedrine, and mephentermine—effectively maintained arterial blood pressure and were safe to use in the treatment of hypotension. Compared to ephedrine and mephentermine, phenylephrine significantly lowered heart rate, which may be helpful for cardiac patients or those in whom tachycardia is not desired
Published Version
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