Abstract
Background: Hypotension is the most common adverse effect in parturients after spinal anaesthesia for Caesarean section. Despite various pharmacological and non-pharmacological methods used in its prevention and treatment, vasopressors have become very important in the management of this form of hypotension. Objective: This study was aimed at comparing the efficacy and safety of prophylactic intravenous infusions of phenylephrine and ephedrine at preventing maternal hypotension during Combined Spinal Epidural anaesthesia (CSE) for Caesarean section. Methods: Sixty ASA I and II patients scheduled for elective Caesarean section, were randomly allocated into two groups. Patients in Group I received Phenylephrine 80 μg/min while patients in Group II received Ephedrine 1 mg/min immediately after the subarachnoid 10 mg plain bupivacaine injection while the epidural catheter was being inserted and secured. All the patients received a crystalloid preload of 1 litre of 0.9% normal saline prior to the induction of CSE. Results: The overall incidence of hypotension was 8.5% (6.7% in the phenylephrine group and 10.3% in the ephedrine groups). The lowest systolic (105.8 ± 9.2 mmHg) and diastolic arterial pressures (60.9 ± 8.9 mmHg) occurred in the ephedrine group while the lowest heart rates occurred in the phenylephrine group. The mean umbilical artery pH was 7.3 while Apgar scores at 1st and 5th min were essentially the same in the two groups. Conclusion: Prophylactic intravenous infusions of phenylephrine and ephedrine are safe and effective at reducing the incidence and severity of hypotension during combined spinal epidural anaesthesia for elective Caesarean section with no associated neonatal acidosis.
Highlights
Caesarean section is frequently performed under regional anaesthesia world-wide following the advantages of this technique over general anaesthesia
Fifty nine (98.33%) patients participated throughout the study while one patient (1.67%) was excluded following conversion to general anaesthesia
The safety and efficacy of prophylactic intravenous infusions of the vasopressors–phenylephrine and ephedrine during combined spinal epidural anaesthesia for Caesarean section was studied in our parturients
Summary
Caesarean section is frequently performed under regional anaesthesia world-wide following the advantages of this technique over general anaesthesia. Regional anaesthesia for Caesarean section is associated with hypotension which predisposes the newborn to acidosis. The acidosis is related to the treatment of hypotension with vasopressors. Severe maternal hypotension gives rise to a reduction in utero-placental perfusion leading to foetalbradycardia and acid-base abnormalities and if prolonged, may lead to neuro-behavioural changes in the newborn [4]. It should be prevented and/or treated promptly. Despite various pharmacological and non-pharmacological methods used in its prevention and treatment, vasopressors have become very important in the management of this form of hypotension
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