Journal article
A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise
International journal of obstetric anesthesia, Vol.33, pp.23-31
02/2018
DOI: 10.1016/j.ijoa.2017.08.001
PMID: 28899735
Abstract
•Randomised trial at caesarean delivery for severe preeclampsia and fetal compromise.•Ephedrine and phenylephrine were compared, for spinal-induced hypotension.•Umbilical arterial base excess, pH, HCO3−, PCO2, lactate, and Apgar scores similar.•Fetal acid-base status was independent of the vasopressor used.•Choice of vasopressor should depend upon individual maternal haemodynamic responses.
Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia.
Patients with preeclampsia requiring caesarean delivery for a non-reassuring fetal heart tracing were randomised to receive either bolus ephedrine (7.5–15mg) or phenylephrine (50–100µg), to treat spinal hypotension. The primary outcome was umbilical arterial base excess. Secondary outcomes were umbilical arterial and venous pH and lactate concentration, venous base excess, and Apgar scores.
Among 133 women, 64 who required vasopressor treatment were randomised into groups of 32 with similar patient characteristics. Pre-delivery blood pressure changes were similar. There was no difference in mean [standard deviation] umbilical artery base excess (−4.9 [3.7] vs −6.0 [4.6] mmol/L for ephedrine and phenylephrine respectively; P=0.29). Mean umbilical arterial and venous pH and lactate concentrations did not significantly differ between groups (7.25 [0.08] vs 7.22 [0.10], 7.28 [0.07] vs 7.27 [0.10], and 3.41 [2.18] vs 3.28 [2.44] mmol/L respectively). Umbilical venous oxygen tension was higher in the ephedrine group (2.8 [0.7] vs 2.4 [0.62]) kPa, P=0.02). There was no difference in 1- or 5-min Apgar scores, numbers of neonates with 1-min Apgar scores <7 or with a pH <7.2.
In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension.
Details
- Title: Subtitle
- A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise
- Creators
- R.A. Dyer - University of Cape TownA. Emmanuel - University of Cape TownS.C. Adams - University of Cape TownC.J. Lombard - South African Medical Research CouncilM.J. Arcache - University of Cape TownA. Vorster - University of Cape TownC.A. Wong - Northwestern UniversityN. Higgins - Northwestern UniversityA.R. Reed - University of Cape TownM.F. James - University of Cape TownY. Joolay - University of Cape TownS. Schulein - University of Cape TownD. van Dyk - University of Cape Town
- Resource Type
- Journal article
- Publication Details
- International journal of obstetric anesthesia, Vol.33, pp.23-31
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.ijoa.2017.08.001
- PMID
- 28899735
- ISSN
- 0959-289X
- eISSN
- 1532-3374
- Language
- English
- Date published
- 02/2018
- Academic Unit
- Anesthesia
- Record Identifier
- 9984296141202771
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