Ephedrine Bolus Research Articles

The Safety and Feasibility of Segmental Thoracic Spinal Anesthesia above Umbilicus and Breast Surgery

This study was conducted on 30 patients aged 16 to 70 years with American Society of Anesthesiology (ASA) physical status I, II, and III. Though general anesthesia (GA) is a universally accepted technique for most abdominal surgeries but not free from drawbacks including poly medicine side effects, prolonged recovery time, and unnoticed inadequate pain control, as well as risk to elderly patients with cardiopulmonary conditions, and safety issue limits the usefulness of general anesthesia. Thus, the new technique adopted attracts the attention of anesthesiologists, as thoracic segmental spinal anesthesia (TSSA) for several common surgeries where local anesthetic agents injected intrathecally above the termination of the spinal cord show value in patients with high risk for general anesthesia who need deep analgesia. The types of surgery were periumbilical hernia 7 (23.33%) in both age groups followed by epigastric hernia 8 (26.66%), neoplastic diseases of breast 6 (20%), laparoscopy cholecystectomy 4 (13.33%), open cholecystectomy 5 (16.66%). The analysis of intraoperative and postoperative mean systolic and diastolic arterial pressures (MAP) of patients up to 24 hours was found insignificant (P>0.05). Regarding the intraoperative hemodynamic changes, hypotension occurred in 3 patients and resolved with a single bolus of ephedrine, no tachycardia occurred, while bradycardia in 3 patients (15%). No patients need to be converted to general anesthesia due to inadequate block. On analysis complications, peri-operative or post-operative period showed that shoulder pain was experienced by 2 patients (6.66%) in the younger age group whereas in the older age group, two patients (6.66%) have hypotension and bradycardia was seen in 3 patients (13.33%). No respiratory complications, such as postoperative pneumonia or atelectasis were noted during the hospital stay with TSSA as well and no nausea/vomiting was noted. This study provides only preliminary evidence to support the feasibility and efficacy of segmental thoracic spinal anesthesia to be used effectively for safe anesthetic technique during routine laparoscopic surgery in normal patients as well as co-morbidity patients with stable intraoperative and post-operative hemodynamic and also avoidance of complications of general anesthesia with these benefits, decrease in length of stay in hospital, reduction of postoperative pain, and increased patients satisfaction. Thus, in future the segmental spinal anesthesia may become a good alternative to general anesthesia in normal patients as well as comorbid patients.

To Compare the Effects of IV Bolus Doses Phenylephrine, And Ephedrine Injection in Maintaining Arterial Blood Pressure During Spinal Anesthesia for Cesarean Sections-A Randomized Comparative Study

Spinal anesthesia is the preferred anesthetic approach for cesarean sections due to its benefits for both the mother and fetus. However, hypotension is a common and potentially harmful complication. Phenylephrine (PE) is frequently used as a vasopressor to manage hypotension during spinal anesthesia, but it can cause maternal sinus bradycardia. This study aimed to compare two strategies for maintaining arterial blood pressure during cesarean delivery: a 20 mcg bolus of phenylephrine followed by a 10 mcg/min infusion (Group P) versus a 6 mg bolus of ephedrine followed by a 0.1 mg/min infusion (Group E). A total of 100 pregnant women scheduled for elective or emergency cesarean sections under spinal anesthesia were randomly assigned to either Group P or Group E. Systolic blood pressure was well-maintained in both groups during the first 20 minutes. After this period, Group P’s blood pressure stabilized towards basal values, while Group E's remained slightly above basal levels—a statistically significant difference (p < 0.005). Diastolic blood pressure fell in both groups, but Group E maintained slightly higher levels than Group P. Group P had a 24% incidence of bradycardia requiring atropine, while no such cases were observed in Group E. Despite these differences, overall maternal arterial blood pressure was effectively maintained in both groups, with no significant difference in uterine tone or bleeding levels.

A Prospective Randomized Double Blind Comparative Study to Determine the Efficacy of Norepinephrine and Ephedrine to Maintain Arterial Blood Pressure During Spinal Anesthesia for Cesarean Delivery

Background: Spinal Anesthesia Induced Hypotension(SAIH) continues to be the troublesome complication for obstetric patients undergoing cesarean section under subarachnoid block. Vasopressors are emerging as the cornerstone of treating SAIH in cesarean section patients with the evolving evidence of arterial vasodilatation as the primary cause of hypotension. This study was hypothesized to compare the efficacy of norepinephrine and ephedrine boluses to maintain hemodynamics in cesarean section.
 Methods: After approval from institutional ethics committee and registration in Clinical Trials Registry India(CTRI ) and informed consent, study was conducted in 110 healthy parturients aged 18-40 years, belonging to ASA physical status I and II, posted for elective cesarean section under spinal anesthesia, were randomly allocated into group N(n=55) and group E(n=55),who received intravenous boluses of norepinephrine 6 g and ephedrine 10mg respectively as prophylaxis(one dose soon after induction) and in treatment of SAIH. The number of vasopressor boluses were recorded as primary objective and hemodynamics, APGAR scores, adverse events were noted.
 Results: The number of boluses of vasopressor used was 1.9±1.2 for Ephedrine and 4.72±2.9 for Norepinephrine. At 30,40,50 and 60 minutes after anesthesia, there was significant fall in mean arterial pressure in the norepinephrine group compared to ephedrine group. The incidence of tachycardia was more in ephedrine group and incidence of bradycardia was more in norepinephrine group.
 Conclusion: Both the study drugs, ephedrine and norepinephrine are comparably effective in preventing SAIH after prophylactic bolus and effective in maintaining blood pressure intraoperatively, more number of boluses of norepinephrine was required compared to ephedrine.

Role of perfusion index in early detection of hypotension following spinal anesthesia for cesarean section

ABSTRACT Background The most common drawback of spinal anesthesia (SA) is hypotension, which has adverse effects on both mother and fetus; consequently, early detection and management of spinal hypotension have been considered a very important topic in obstetric anesthesia. Additionally, the capability to ultimately diagnose hypotension could permit initiation of adequate treatment. The standard method to estimate blood pressure during cesarean section is noninvasive blood pressure measurement. However, periods of hypotension could be missed within a reasonable time frame. Methods Perfusion index (PI) and blood pressure were measured in 100 pregnant women during elective cesarean section under SA. Results PI had a significant negative correlation with the change occurred in systolic blood pressure (SBP) (r = −.432, p < .0001); by using univariate linear regression analysis, the PI explains 20.2% of variability in SBP as PI significantly predicts the change occurred in SBP (F = 24.8, p < .0001), as each one unit increase in PI, accompanied by a significant decrease in SBP by 2.089 (mm/hg), as (b, t, p) (−2.089, −4.987, .0001), respectively. There was a significant difference in SBP and PI before and after giving oxytocin bolus [(z = −1.9, P = .05) and (z = −4.3, P < .0001), respectively]. By comparing PI before vs. after taking ephedrine bolus, there was a significant decrease in median of PI [median of PI before 10 (5.5–15) vs. median of PI after 7.5 (6–15.5) (z = −6.6, P < .0001)]. Discussion After SA with sympathetic blockade, peripheral vascular tone declined and therefore PI increased. Conclusion PI could anticipate the incidence of hypotension during cesarean delivery with SA. Ephedrine effect could be evaluated rapidly by the alteration in the PI so that further need can be judged. Oxytocin has a significant impact on vascular tone with 5 international unit bolus, although it does not have a significant effect on blood pressure.

The use of epinephrine infusion for the prevention of spinal hypotension during Caesarean delivery: A randomized controlled dose-finding trial

BackgroundThis study aimed to compare three epinephrine doses for the prevention of spinal hypotension during Caesarean delivery. MethodsThis randomized controlled trial included full-term pregnant women undergoing elective Caesarean delivery under spinal anesthesia. The participants received prophylactic epinephrine infusions at rates of 0.01, 0.02, or 0.03 mcg/kg/min. Spinal hypotension (systolic blood pressure <80% of baseline) was managed with a 9-mg ephedrine bolus. The primary outcome was the incidence of spinal hypotension. Secondary outcomes included total ephedrine requirement, the incidence of severe spinal hypotension, excessive tachycardia and hypertension, and neonatal outcomes. ResultsThe final analysis included 271 patients. The incidence of hypotension was lowest in the 0.03 mcg group (11/90 [12%]), followed by the 0.02 mcg (32/91 [35%]) and the 0.01 mcg (55/90 [61%]) groups (p < 0.001). The median ephedrine requirements (quartiles) were also the lowest in the 0.03 mcg group (0 [0−0] mg), followed by the 0.02 mcg (0 [0–9] mg) and the 0.01 mcg (9 [0–18] mg) groups. The incidence of severe hypotension was lower in the 0.03 mcg and 0.02 mcg groups than in the 0.01 mcg group (3/90 [3%], 5/91 [6%], and 15/90 [17%], respectively). The incidences of excessive tachycardia, hypertension, and neonatal outcomes were comparable among the groups. ConclusionThe use of epinephrine to prevent spinal hypotension during Caesarean delivery is feasible and effective. An initial dose of 0.03 mcg/kg/min produced the lowest incidence of hypotension compared to 0.02 mcg/kg/min and 0.01 mcg/kg/min doses. The three doses were comparable in terms of the incidence of tachycardia, hypertension, and neonatal outcomes. Study registrationClinicalTrials.gov Identifier: NCT05279703.

Ephedrine Infusion with Rescue Ephedrine Boluses versus Rescue Boluses alone for Preventing Hypotension during Spinal Anesthesia for Cesarean Delivery.

Background: Maternal hypotension is an unwanted consequence of the physiologic onset of spinal blockade, and causes both maternal and fetal effects. Maternal symptoms include nausea, vomiting, and a sense of ‘‘impending doom’’ from inadequate cerebral perfusion. Inadequate treatment of hypotension can ultimately end with the loss of consciousness and cardiovascular collapse.&#x0D; Materials and methods: We included 80 full term parturient (ASA I or II) with uncomplicated pregnancies. The patients were prospectively randomized into two groups. 80 patients received 1000 mL NaCl 0,9 % solution before the initiation of spinal anesthesia. Maternal systolic blood pressure was measured every 1 minutes (for first 10 minutes) and then every 3 minutes. One group received ephedrine infusion (1 mg/min) with rescue ephedrine boluses (10 mg), (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients) and the other received rescue boluses alone (10 mg) , (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients).&#x0D; Results: Gr 1 (Ephedrine infusion with rescue ephedrine boluses). The incidence of hypotension was at 8 patients (8/40 [20%]),(when an absolute value of less than 90 mmHg).&#x0D; Gr 2 (rescue boluses ephedrine alone). The incidence of hypotension was at 32 patients (32/40 [80%]), (when an absolute value of less than 90 mmHg).&#x0D; Group 2 had a higher incidence of hypotension compared with group 1 (32/40 [80%]) vs (8/40 [20%]).&#x0D; Neonatal outcomes were not different between the 2 groups.&#x0D; Conclusion: Prophylactic variable rate ephedrine infusion and rescue ephedrine bolus dosing is more effective than relying on rescue ephedrine bolus dosing with respect to limiting clinician workload and maternal symptoms during spinal anesthesia for cesarean delivery.Maternal hypotension

Comparison of norepinephrine with ephedrine boluses for the treatment of maternal hypotension during cesarean section under spinal anesthesia: A prospective observational study

Comparison of norepinephrine with ephedrine boluses for the treatment of maternal hypotension during cesarean section under spinal anesthesia: A prospective observational study

Comparison of Bolus Ephedrine vs Mephentermine in the Management of Hypotension during Spinal Anaesthesia for Caesarean Section: A Randomised Clinical Trial

Introduction: Ephedrine and mephentermine are synthetic sympathomimetic drugs used as vasopressors. Ephedrine has direct and indirect effects on α, b1, and b2 receptors, and it also releases endogenous norepinephrine from synaptic storage sites. This leads to an elevation in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). On the other hand, mephentermine indirectly stimulates beta-adrenergic receptors and to some extent alpha-adrenergic receptors as well. Its primary effect is cardiac stimulation, which increases peripheral vascular resistance and contributes to an increase in blood pressure. Aim: The aim of this study is to examine the efficacy of ephedrine and mephentermine in the treatment of hypotension during Lower Segment Caesarean Section (LSCS). Materials and Methods: This double-blinded randomised clinical trial was conducted in the Department of Anaesthesiology among 90 pregnant females scheduled for caesarean delivery at Hind Institute of Medical Sciences, Sitapur, India from January 2021 to December 2022. Patients who developed hypotension (SBP &lt;90 mmHg or &lt;20% of the baseline) after receiving spinal anaesthesia were included in the study and divided into two groups. Group A received an intravenous bolus of 6 mg of ephedrine, and group B received an intravenous bolus of 6 mg of mephentermine. The variables studied included age, height, weight, Mean Arterial Pressure (MAP), Heart Rate (HR), SBP, DBP, bolus doses, and any side effects that occurred. HR, SBP, and DBP were recorded at baseline and then monitored every two minutes for a total of 10 minutes, and then every five minutes until the end of surgery. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 21.0 for Windows, and the results were represented as numbers (%) and mean±Standard Deviation (SD). Results: The mean age of patients in group A and group B was 24.35 years and 24.72 years, respectively. All vital parameters were comparable. The need for bolus doses after hypotension was significantly higher in group B (1.68±0.81) than in group A (mean 1.28). The statistically significant complications identified were tachycardia, nausea, and vomiting, which were more prevalent in group B with 13 and 16 patients, respectively. Conclusion: In this study, the authors found that ephedrine was more effective than mephentermine in terms of the requirement for bolus doses and the occurrence of intraoperative side effects. The requirement for bolus doses and occurrence of significant complications were higher in the group that received mephentermine. Therefore, ephedrine bolus immediately following spinal anaesthesia would be a safe and effective technique for preventing hypotension in females scheduled for Lower Segment Caesarean Section (LSCS).

1142: ANAPHYLACTIC REACTION AFTER SUGAMMADEX ADMINISTRATION

Introduction: Anaphylaxis in the perioperative and operative period is a potentially life-threatening reaction to medications or substances, most commonly neuromuscular blocking agents (NBMAs), antibiotics, disinfectants, and latex. The most frequently used NBMAs are succinylcholine and rocuronium, but sugammadex - typically used for rocuronium reversal and controversially touted as a possible treatment for rocuronium-induced anaphylaxis - has been increasingly reported in the literature as an anaphylaxis trigger itself. Description: A 44 year-old male with a past medical history significant for traumatic brain injury (TBI) and cerebral palsy presented with skin changes around his baclofen pump. He was admitted and taken to the operating room for pump explantation. There were no issues with induction of anesthesia. After pump explantation, 200mg of sugammadex was administered for reversal of rocuronium. Four minutes later, the patient’s blood pressure (BP) dropped to 58/32mmHg. The patient’s hypotension persisted despite boluses of epinephrine, phenylephrine, ephedrine, and albumin. For presumed anaphylactic reaction, the patient was given 100mg of hydrocortisone and further doses of epinephrine. A tryptase level was also sent. The patient became hemodynamically stable during his first day in the intensive care unit. The tryptase level down-trended from 44.9 micrograms/liter (mcg/L) initially to 6.8mcg/L after two days (normal: 2.2-13.2 mcg/L). The patient was safely discharged on hospital day 9. Discussion: Sugammadex-induced anaphylaxis is an emerging, life-threatening complication experienced during anesthesia. Management includes airway and hemodynamic support (with epinephrine), withdrawal of the offending agent, and serum tryptase measurements as a marker of mast cell activation in anaphylaxis. While NBMA-associated anaphylaxis is commonly peri-intubation and sugammadex reactions are typically peri-extubation, patients can also be allergic to the sugammadex-rocuronium complex, further complicating attempts to distinguish between the two for future avoidance. As research is devoted towards understanding sugammadex anaphylaxis and possible alternative approaches, providers will have more information for determining the risks and benefits of different anesthetic methods in patients.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Vision loss, third and fourth nerve palsy and non‐responsive midriasis after contralateral retrobulbar anaesthesia

AbstractPurpose: The purpose of this communication is to report a case of vision loss, third, and fourth nerve palsy and midriasis after contralateral retrobulbar anaesthesia. Although contralateral vision loss has been reported after locoregional block, very little evidence has been found about contralateral extraocular movement palsy and midriasis. Mechanism is not well known, though it is believed to be a consequence of the accidental subdural/subarachnoid anaesthetic injection.Methods: A case which took place at our hospital was selected. A retrobulbar block was performed by the service of anesthesiology in an 80‐year‐old patient prior to cataract surgery on the right eye. The block consisted of a 5 ml injection of 0.5% levobupicain and 2% lidocain (1:1) in his right eye under monitorization and sterile conditions. 10 min after the injection the patient presented bradycardia, hypotension and decreased consciousness. He was administered 0.6 mg atropine, 3 ephedrine bolus and 8 migr noradrenaline and his constants came back to normality. He was kept in observation in the recovery room. After consciousness recovery he claimed vision loss in the fellow eye.Results: At the exploration we found complete vision loss with no light perception, ptosis, third and fourth nerve palsy and dilated and non‐responsive pupil in the left eye. Funduscopy was unremarkable. He was kept in observation and 45 min later he was reexplored: ptosis, extraocular movements and pupil size improved; 2 h later exploration was completely normal.Conclusions: To conclude, we wanted to remember some of the possible complications of retrobulbar block and the importance of its conscious selection. Above all, we wanted to highlight this infrequent reaction on the fellow eye about which we have found very little evidence.

Effectiveness of Prophylactic Bolus Ephedrine Versus Norepinephrine for Management of Postspinal Hypotension during Elective Caesarean Section in Resource Limited Setting: A Prospective Cohort Study.

Background Spinal anaesthesia for caesarean section is the preferred technique since it provides better maternal safety and neonatal outcome compared to general anaesthesia. Hypotension is the most common complication after spinal anaesthesia. The study aims to determine the effectiveness of a prophylactic bolus dose of norepinephrine and ephedrine on the management of postspinal hypotension during caesarean section. Method An institutional-based prospective cohort study was conducted on 84 pregnant women undergoing elective caesarean section. Based on the responsible anaesthetist's postspinal hypotension management plan, patients were divided into two groups. Those patients who received ephedrine are grouped into the ephedrine (EPH, n = 42) group, and patients who received norepinephrine are grouped under the norepinephrine group (NE, n = 42) by data collectors. After aseptic technique, spinal anaesthesia was administered with 0.5% (3 ml) bupivacaine using a 23G spinal needle. During spinal anaesthesia, a prophylactic bolus dose of 10 mg (2 ml) EPH or 16 g (2 ml) NE was given based on management plan of the shift anaesthetist. Mean arterial pressure (MAP), the heart rate (HR), number of boluses of vasopressor used, incidence of nausea and vomiting, and the Apgar score of babies at 1 and 5 min between the groups were recorded. Results The norepinephrine group had a statistically significant higher MAP compared to the ephedrine group in the first 10 and 15 min (p < 0.05) of the study period. Thereafter, there was no statistically significant difference in MAP between the groups until the end of the study period (p > 0.05). The ephedrine group had a statistically significant higher heart rate throughout the procedure compared to the norepinephrine group (p < 0.05). The norepinephrine group required a lower bolus number of vasopressors compared to the ephedrine group to maintain blood pressure. The Apgar scores of all babies at 1 and 5 min were above seven. Significant differences regarding maternal complications (nausea and vomiting) between the groups were not detected (nausea, p=0.21 and vomiting, p=0.092). Conclusion Norepinephrine can be used instead of ephedrine to keep a pregnant mother's blood pressure stable during a caesarean section under spinal anaesthesia without causing harm to the mother or baby. Trial registration. ClinicalTrials.gov Identifier: NCT05522088 (Date of registration: 30/08/22).

Randomized trial of bolus ephedrine or mephentermine for maintenance of arterial pressure and fetal outcome during spinal anesthesia for the cesarean section

Background and Aims: Spinal anesthesia remains the preferred choice for cesarean deliveries, but hypotension is one of the common complications which may have detrimental effects on both the mother and fetus. In this study, we compared the efficacy and adverse effects of bolus doses of ephedrine hydrochloride and mephentermine sulfate administered intravenously to treat spinal-induced hypotension and the fetal outcomes through Apgar scores and umbilical cord blood gas analysis in the lower segment cesarean section. Material and Methods: In this prospective, randomized, double-blind study, 60 patients undergoing the lower segment cesarean section (LSCS) under spinal anesthesia were randomized into two groups of 30 each using computer-generated random numbers which were kept in an opaque envelope. Patients were pre-loaded with Ringer's lactate solution 10 ml/kg before the spinal anesthesia. Hypotension was defined as the fall in systolic blood pressure of less than or equal to 20% of the baseline or systolic blood pressure of less than 90 mmHg. Whenever hypotension occurred, patients in group E (ephedrine) received a bolus dose of ephedrine 6 mg intravenous and patients in group M (mephentermine) received a bolus dose of mephentermine 6 mg intravenous. Intra-operative recording included maternal hemodynamic parameters and the number of bolus doses of study drugs required to treat maternal hypotension and the adverse effects of study drugs. The Apgar score and umbilical cord blood gas values were recorded. Data were analyzed by analysis of variance test, Student's t-test, and Chi-square test. A P value of < 0.05 was considered as significant. Results: There was a statistically significant (p < 0.05) increase in systolic and mean arterial blood pressure at the second min and fourth min after administration of ephedrine in group E compared to mephentermine in group M. The systolic blood pressure at the second min in the ephedrine group was 114.3 ± 12.06, whereas in the mephentermine group, it was 106.10 ± 8.41 and was statistically significant (p < 0.05). At the fourth min, the systolic blood pressure in the ephedrine group was 115.03 ± 8.87, whereas in the mephentermine group, it was 108.46 ± 8.10 and was statistically significant (p < 0.05). There was a transient increase in heart rate immediately after administration of spinal anesthesia. The mean number of bolus doses of vasopressor consumption was 2.4 (14.4 mg) in the ephedrine group and 2 (12 mg) in the mephentermine group. The umbilical cord blood gas analysis and Apgar scores were similar in both the groups. Three patients (10%) developed bradycardia in the mephentermine group compared to the ephedrine group (0%). The incidence of nausea (13.3% vs 3.3%) and vomiting (10% vs 1%) was higher in the ephedrine group compared to the mephentermne group, and it was not statistically significant (p > 0.05). No significant differences were observed in the umbilical arterial blood pH and Apgar scores. Conclusion: In conclusion, after hypotension, ephedrine and mephentermine administration as bolus doses are equally efficacious in preventing spinal-induced hypotension in patients undergoing the cesarean section and are associated with similar neonatal outcomes.

Effect of prophylactic combination of glycopyrrolate, ondansetron, and ephedrine upon hypotension during obstetric spinal anaesthesia-A randomised controlled trial.

Background and Aims:Various pharmacological and non-pharmacological strategies have been employed to minimise hypotension during obstetric spinal anaesthesia. We compared a prophylactic combination of glycopyrrolate, ondansetron, and ephedrine in terms of total vasopressor consumption, with standard treatment in this randomised controlled trial.Methods:One hundred patients undergoing elective caeserean sections were randomly divided into two groups of 50 each, the study group received prophylactic ondansetron and glycopyrrolate boluses followed by an infusion of ephedrine, while the control group received ephedrine boluses as required. The total ephedrine consumption (primary objective), incidence and degree of hypotension, heart rate variations, and neonatal APGAR scores (secondary objectives) were analysed.Results:The median ephedrine requirement was lesser in the study group compared to the control group [13.2 mg (10--15.75) vs. 27.7 mg (12--24)], with a P value of 0.02. Fewer participants experienced hypotension in the study group before baby delivery compared to the control group (12 vs. 36, P = 0.004). Heart rate was higher in the study group. No significant differences were observed in neonatal APGAR scores and incidence of adverse events.Conclusion:A combination of glycopyrrolate, ondansetron, and ephedrine might offer better haemodynamic stability and reduce vasopressor consumption in obstetric patients undergoing spinal anaesthesia as opposed to standard treatment.

Comparison of Norepinephrine and Ephedrine Boluses in the Control of Spinal Anesthesia-Induced Hypotension during Cesarean Section: A Randomized Controlled Trial

Introduction: Phenylephrine and ephedrine are the first-line vasopressors used in obstetric anesthesia to manage maternal hypotension, but phenylephrine is sometimes associated with maternal cardiac depression, limiting its use among mothers with cardiac comorbidities. The use of ephedrine is generally associated with maternal tachycardia along with a decrease in fetal pH. Norepinephrine is another vasopressor that has recently been introduced in obstetrical anesthesia and has attracted increasing attention as a feasible substitute for these two molecules in this context. The objective of our study is to compare two vasopressor agents (norepinephrine vs ephedrine) dedicated to the treatement of post-spinal anesthesia hypotension, and then to define the place of norepinephrine in the pharmacopoeia of the latter. Materials and Method: A Randomized controlled study of 80 ASAI parturient randomized to receive either 8µg boluses of norepinephrine (NG)or 6mg boluses of ephedrine(EG).The criteria for judgment included the occurrence of tachycardia, the maintenance of blood pressure, and the number of boluses required, as well as the clinical condition of the neonate. Results: The incidence of tachycardia (HR&gt;80bpm) was lower in NG (18%) compared to that in EG(67.6%) p=0.0001, crude Odds Ratio 14.968 95% CI] 4.924, 45.505[ . Six in NG (12%) and eight in EG (26.7%) patients experienced nausea, OR 2.667 95% CI] 0.823-8.641[while only three in NG (6%), and four EG (13%) patients experienced vomiting p=0.41 OR:2.41 CI 95% ]0.501-11.605[. Blood pressure was stablefor both groups but with a superiority of norepinephrine which allowed more marked maintenance: 75% to 112% of the initial systolic value in NG versus 72% to 100% in EG), the difference was highly significant p&lt;0.0001. No significant differences in neonatal outcomes were observed. Conclusion: Norepinephrine can maintain blood pressure more effectively than ephedrine with less incidence of tachycardia .............

Atrial fibrillation secondary to ephedrine administration and responsive to lidocaine in a Shiloh shepherd dog

AbstractA 6‐year‐old, 43 kg, male Shiloh shepherd dog was anaesthetised for computed tomography to investigate the source of respiratory distress, lethargy and decreased appetite. Arterial hypotension during anaesthesia was treated with an infusion of phenylephrine and a bolus of ephedrine, 0.05 mg/kg intravenously (IV). Ephedrine resulted in increased blood pressure and reflexive bradycardia; atrial fibrillation developed immediately after. Approximately 10 minutes later, a bolus of lidocaine 2 mg/kg IV was administered, and normal sinus rhythm was restored within 1 minute. Lone atrial fibrillation may be triggered by agents or disease processes that increase vagal activity. While lidocaine has historically been used only to treat unstable ventricular dysrhythmias, it is effective for terminating this particular type of atrial fibrillation.

Norepinephrine as an Alternative in Hypotension Prophylaxis During Cesarean Sectionunder Spinal Anesthesia

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections (C.S.) due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Thus we compare the administration of intermittent I.V. boluses of norepinephrine and ephedrine to guard against the hypotensive effect of spinal anesthesia during cesarean delivery. Patients and Methods 120 female patients undergoing electiveC.S.were randomly divided into “group-E” for Ephedrine and “group-N” for Norepinephrine. Results Compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

Norepinephrine versus Ephedrine Boluses To Treat Spinal-Induced Hypotension in Cesarean Deliveries

Abstract Corresponding Background Cesarean sections normally require an anesthetic block at T4 level, so hypotension is reported to occur in up to 80% of spinal anesthesia cases. When maternal hypotension associated with spinal anesthesia for cesarean section is severe and sustained, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow with consecutive fetal hypoxia, acidosis, and neurological injury. Aim of the Work to compare the administration of intermittent i.v. boluses of norepinephrine and ephedrine to counterbalance the hypotensive effect of spinal anesthesia during cesarean delivery. The results of the study showed that compared with ephedrine, norepinephrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery. Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in norepinephrine compared with the use of ephedrine. Conclusion Norepinephrine can be used as an alternative vasopressor to maintain maternal blood pressure during spinal anesthesia for cesarean delivery, with no adverse effect on neonatal outcome.

Role of Prophylactic Bolus Dose of Ephedrine to Prevent Hypotension after Spinal Anesthesia; A Single Center Experience

Aim: To compare the efficacy of prophylactic bolus dose of ephedrine 10mg to prevent hypotension after spinal anesthesia for elective caesarean section. Methods: The study was conducted in Gynecological operation theatre suite of Bahria international teaching Hospital Lahore, from 15th September 2020 to 14th January 2021. It was quasi experimental study. It was conducted on ninety women admitted in gynecology department of Bahria international teaching Hospital Lahore, for caesarean delivery. These women were divided randomly into 2 groups: a) Patients in group E10 received ephedrine 1ml from 5ml syringe containing ephedrine 10mg/mland b)’ Results: Patients in group R acted as a control group and received normal saline 1ml from 5ml syringe.Blood pressure was recorded every minute for first 3 minutes, every 2 minutes for next 6 minutes, and then every 3 minutes till the procedure was completed. The sampling technique used was purposive sampling. Conclusion: It was concluded that prophylactic intravenous ephedrine bolus 10mg is more effective in preventing hypotension than fluid preload alone. It is simple and effective means of reducing the incidence of hypotension undergoing C- section in spinal anaesthesia. Keywords: Ephedrine, Hypotension, Spinal anesthesia.

COMPARISON OF THE EFFECT OF PHENYLEPHRINE AND EPHEDRINE ON UMBILICALARTERIAL BLOOD GAS PARAMETERS IN ELECTIVE CAESAREAN SECTION UNDER LUMBAR SUBARACHNOID BLOCK

Introduction: Potential side effects such as supraventricular tachycardia, tachyphylaxis, and most importantly, fetal acidosis render the use of ephedrine as a rst line agent to treat hypotension in obstetric patient debatable. Phenylephrine, an alternative drug, has a reduced incidence of nausea and vomiting as well as decreased fetal acidosis, which gives it an advantage over the use of ephedrine. Materials and methods: We conducted an observational study in 68 ASA II patients scheduled for lower segment caesarean section. Parturients who satised the inclusion criteria were randomly assigned into one of the two groups of 34 each- group P with parturients who were to receive phenylephrine boluses in 100 mcg increments and group E with parturients who were to receive ephedrine boluses in 6mg increments when they developed hypotension. Fetal umbilical arterial blood gas was analyzed and parameters were compared. Results: On analyzing umbilical arterial blood values, a lower mean pH was found in group E (7.27± 0.09) when compared to group P (7.3± 0.04). Also a higher PCO value (49± 7.4) was found in group E when compared to group P (43.9 ± 6.4). Other umbilical arterial blood gas values were 2 comparable between both groups