A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise
| Autor: | S.C. Adams, A. Emmanuel, A.R. Reed, S. Schulein, Cynthia A. Wong, D. van Dyk, M.J. Arcache, A. Vorster, Nicole Higgins, Carl Lombard, Robert A. Dyer, Michael F. M. James, Yaseen Joolay |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Blood Pressure Preeclampsia 03 medical and health sciences Phenylephrine Young Adult 0302 clinical medicine Bolus (medicine) Pre-Eclampsia 030202 anesthesiology Pregnancy medicine.artery Medicine Anesthesia Obstetrical Humans Vasoconstrictor Agents 030212 general & internal medicine Lactic Acid Ephedrine Fetus business.industry Cesarean Section Infant Newborn Obstetrics and Gynecology Umbilical artery Hydrogen-Ion Concentration medicine.disease Fetal Blood Oxygen Fetal Diseases Anesthesiology and Pain Medicine Blood pressure Anesthesia Base excess Female Hypotension business Acidosis medicine.drug |
| Zdroj: | International journal of obstetric anesthesia. 33 |
| ISSN: | 1532-3374 |
| Popis: | Background 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. Methods 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. Results 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 Conclusions 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. |
| Databáze: | OpenAIRE |
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