Hamid, Azhari
(2006)
The effect of phenylephreni and ephedrine in fetal outcome in the treatment of hypotension during spinal anaesthesia for caesarean delivery.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background:
Sympathetic blockade manifested by hypotension is one of the most common
complications of the regional anaesthesia in obstetric patients. Its prophylaxis and
treatment are primarily directed towards the concern that hypotension may result in
decreased utero placental perfusion, thus compromised fetus and maternal. Various drugs
and methods have been used in attempts to attenuate this response but all have
limitations. Many studies using phenylephrine or ephedrine as a prophylaxis drug to
suppress these reflexes had shown promising results and reduce the occurrence of fetal
acidosis. As both phenylephrine and ephedrine had rapid onset and short duration of
action, we formulated a comparative study to evaluate the capability of this drug to
reduce the fetal acidosis in the treatment of hypotensive response to spinal anaesthesia.
Objectives:
The objectives of this double-blinded, randomized study were to compare the fetal
outcome after given phenylephrine or ephedrine as a treatment of hypotension in spinal
anaesthesia during caesarean delivery.
Methods:
Fifty four patients, ASA physical status I or ll, undergoing elective lower segment
caesarean section surgery were assigned randomly in a double blind, to receive bolus
dose of either ephedrine (6mg/ml) or phenylephrine (200mcg/ml), given intravenously asa treatment of hypotension post spinal anaesthesia Heart rate (HR.), systolic blood
pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were
recorded prior to spinal anaesthesia as baseline To and every minute after spinal
anaesthesia untill delivery of the fetus. At delivery, the umbilical artery blood was
obtained and acid base analysis performed. Apgar scores at 1 and 5 min after delivery
was recorded. Patients were also monitored for complications such as nausea, vomiting
and arrhythmia.
Results:
Both ephedrine and phenylephrine groups showed the increase of SBP, DBP and MAP
in the treatment of hypotension. Phenylephrine group showed mean umbilical artery pH
7.314 when compared to ephedrine (control) group 7.279. The entire increased in
umbilical artery pH was significant statistically. Total overall complications were also
significantly lower in phenylephrine group when compared to ephedrine (control) group.
Conclusion:
Phenylephrine was able to increase the mean fetal umbilical artery pH in the treatment of
hypotension in post spinal anaesthesia patients when compared to ephedrine (control)
group. The total complications also were lower in patients treated with phenylephrine.
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