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. 2010 Apr 30;6(2):257-63.
doi: 10.5114/aoms.2010.13905.

Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Chandrakala P Gunda  1 , Jennifer Malinowski, Aruna Tegginmath, Venkatesh G Suryanarayana, Sathees B C Chandra
Affiliations

Vasopressor choice for hypotension in elective Cesarean section: ephedrine or phenylephrine?

Chandrakala P Gunda et al. Arch Med Sci. .

Abstract

Introduction: Hypotensive episodes are a common complication of spinal anesthesia during Cesarean section. The purpose of this study was to compare the effectiveness and the side effects of vasopressors, ephedrine and phenylephrine, administered for hypotension during elective Cesarean section under spinal anesthesia.

Material and methods: The study consisted of 100 selected ASA I/II females scheduled for elective Cesarean section under spinal anesthesia. Each patient was randomly assigned to one of the two double-blind study groups. Group E received 1 ml ephedrine (5 mg/ml) with normal saline if hypotension was present (n=50). Group P received 1 ml phenylephrine (100 µg/ml) with normal saline if hypotension developed (n=50). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) were compared within and between groups to basal levels at time increments of 0, 2, 4, 6, 8, 10, 15, 20, 25, 30, 45, and 60 min from start of surgery. Incidence of side effects and neonatal outcomes were studied between groups.

Results: All patients required vasopressor therapy for hypotension. Administration of phenylephrine was associated with significant drop in HR. Changes in SBP, DBP, and MAP were similar in both groups for most observed times. The incidences of nausea/vomiting and tachycardia were significantly higher in the ephedrine group.

Conclusions: Phenylephrine and ephedrine are acceptable choices to combat maternal hypotension related to spinal anesthesia in elective Cesarean section. Complications of intra-operative nausea and vomiting, tachycardia and bradycardia should be considered when choosing a vasopressor, suggesting phenylephrine may be more appropriate when considering maternal well-being.

Keywords: Cesarean section; ephedrine; phenylephrine; spinal anesthesia.

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Figures

Figure 1
Figure 1
A – Mean heart rate (HR) values for ephedrine and phenylephrine mean±SD, and B – percent difference between measured HR levels and basal values
Figure 2
Figure 2
A – Mean systolic blood pressure values for ephedrine and phenylephrine mean ± SD and B – mean diastolic blood pressure values for ephedrine and phenylephrine mean± D
See this image and copyright information in PMC

References

    1. Sreevidya S, Sathiyasekaran BW. High caesarean rates in Madras (India): a population-based cross sectional study. BJOG. 2003;110:106–11. - PubMed
    1. Sufang G, Padmadas SS, Fengmin Z, Brown J, Stones RW. Delivery settings and caesarean section rates in China. Bull World Health Organ. 2007;85:755–62. - PMC - PubMed
    1. Smith GC, Cordeaux Y, White IR, et al. The effect of delaying childbirth on primary Cesarean section rates. PLoS Med. 2008;5:1123–32. - PMC - PubMed
    1. Festin MR, Laopaiboon M, Pattanittum P, Ewens M, Henderson-Smart D, Crowther C. Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes. BMC Pregnancy Childbirth. 2009;9:17. - PMC - PubMed
    1. Stamer UM, Wiese R, Stuber F, Wulf H, Meuser T. Change in anaesthetic practice for Caesarean section in Germany. Acta Anaesthesiol Scand. 2005;49:170–6. - PubMed