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Comparison of Maternal Hemodynamic Effects of Ephedrine, Phenylephrine, and Combination Infusion during Spinal Anesthesia for Cesarean Delivery
Abstract Number: 210
Abstract Type: Original Research
Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal and neonatal effects. Single treatment with ephedrine does not reliably prevent spinal anesthesia-induced hypotension and phenylephrine alone treatment induces severe bradycardia. However, the combined treatment of phenylephrine with ephedrine as an infusion was observed to be effective without bradycardia.
There were many studies to compare the effectiveness of above three methods to prevent hypotension following spinal anesthesia for cesarean delivery, but no study to investigate hemodynamic parameters using non-invasive cardiac output measurement method.
Method: Thirty-two term parturients were randomized to receive ephedrine infusion, phenylephrine infusion and combination of ephedrine and phenylephrine(groups E, group P and group EP, respectively) simultaneously with spinal anesthesia. Hemodynamic parameters, such as SBP, PR, CI, SVRI,SVI, were measured before and until 15 minutes after spinal anesthesia. Hypotension was defined as a systolic blood pressure below 100 mmHg or a decrease of 20% from a baseline value. Rescue boluses comprised of phenylephrine 100mcg.
Results: There was no statistically significant differences in all hemodynamic parameters among three groups. However, E group was a statistically significant lower than P group in 1 min APGAR score. (P = 0.008). Otherwise total fluid intake, phenylephrine rescues, umbilical vein pH did not show significant differences.
Conclusion: All methods are effective to prevent hypotension following spinal anesthesia for cesarean section. However, although there was no fetal acidosis, 1 minute APGAR scoer of ephedrine group was lower than that of other two groups, especially, statistically significant lower compared to that of phenylephrine alone group.