Title: Comparison of Prophylactic Infusion of Phenylephrine with Ephedrine For Prevention of Hypotension in Hysterectomies Under Spinal Anaesthesia: A Randomized Clinical Trial
Authors: Dr Manoranjan Mahapatra, Dr Aratiprava Sahu
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.127
Abstract
Aim: Our aim was to assess and compare the effectiveness of prophylactic infusion of ephedrine and phenylephrine given in maintenance of arterial pressure during hysterectomies under sub-arachnoid block.
Methods: The present study was conducted on 80 patients undergoing elective hysterectomies under spinal anaesthesia belonging to American society of Anaesthesiologists Grade I and Grade II physical status. Group P– Phenylephrine 15 micrograms/min. Group E– Ephedrine 1.5 mg/min. Haemodynamic data was collected in both the groups and observations of the analysed data are presented as mean ± standard deviation.
Results: The prophylactic infusion of phenylephrine and ephedrine were effective in maintenance of arterial pressure within 20% limit of baseline. Additional bolus dose requirement was more in ephedrine group than phenylephrine. There was a reduction in heart rate with Phenylephrine and a rise in heart rate with ephedrine.
Conclusion: Although both drugs were effective in maintaining arterial blood pressure within normal range, Phenylephrine is more efficacious in comparison to ephedrine and additional bolus dose requirement is less with phenylephrine.
Keyword: phenylephrine, ephedrine, hysterectomies, spinal anaesthesia
References
- Mercier FJ, Riley ET, Fredericson WL, Roger-Christoph S, Benhamou D, Cohen SE. Phenylephrine added to prophylactic ephedrine infusion during spinal anaesthesia forelective Caesarean section. Anaesthesiology 2001; 95: 668–74.
- NganKee WD, Lee A. Multivariate analysis of factors associated with umbilicalarterial pH and standard base excess after Caesarean section under spinalanaesthesia. Anaesthesia. 2003 Feb;58(2):125-30.
- NganKee WD, Khaw KS, Ng FF. Comparison of Phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia forCaesarean section.Br J Anaesth. 2004 Apr;92(4):469-74.
- NganKee WD, Khaw KS, Ng FF: Prevention of hypotension during spinal anaesthesiafor caesarean delivery: An effective technique using combination phenylephrineinfusion and crystalloid cohydration. Anaesthesiology, 2005; 103: 744–50.
- Sarvanan, MKocarev R. C. Wilson E. Watkins et al. Equivalent dose ofephedrine and phenylephrine in the prevention of post-spinal hypotension incaesarean section. British J. of Anaesthesia 2006(1):95-9.
- NganKee WD, Khaw KS. Vasopressors in obstetrics: what should we be using? Curr Opin Anaesthesiol. 2006 Jun;19(3):238-43.
- NganKee WD, Lee A, Khaw KS, Ng F, Karmakar MK, Gin T. A RandomizedDouble-Blinded Comparison of phenylephrine and ephedrine Infusion Combinationsto maintain blood pressure during spinal anaesthesia for caesarean delivery: The effectson foetal acid-base status and hemodynamic control. AnesthAnalg2008;107:1295-1302
- Cooper DW, Carpenter M, Mowbray P, Desira WR, Ryall DM, Kokri MS. Foetaland maternal effects of Phenylephrine and ephedrine during spinal anaesthesia for caesarean delivery. Anaesthesiology. 2002 Dec;97(6):1582-90.
- Ngan Kee WD, Khaw KS, Lee BB, et al: A dose-response study of prophylactic ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg2000; 90:1390-1395.
- Moran D. H, Perillo M, LaPorta R F, Bader AM, Datta S. Phenylephrine in theprevention of hypotension following spinal anaesthesia for caesarean delivery. JClinAnesth. 1991 jul-Aug; 3(4):301-5.
- Thomas DG, Robson SC, Redfern N, Hughes D, Boys RJ. Randomized trial ofbolus Phenylephrine or ephedrine for maintenance of arterial pressure duringspinalanesthesia for Caesarean section. Br J Anaesth. 1996 Jan;76(1):61-5
- Lee A, NganKee WD, Gin T. A quantitative, systematic review of randomizedcontrolled trials of ephedrine versus Phenylephrine for the management ofhypotension during spinal anaesthesia for caesarean delivery. AnesthAnalg. 2002 Apr;94(4):920-926.
- Reynolds F, Seed PT: Anesthesia for caesarean section and neonatal acid-base status: A meta-analysis. Anesthesia2005; 60:636-653.
- Sahu D, Kothari D, Mehrotra A. Comparison of bolus Phenylephrine, ephedrine,and Mephentermine for maintenance of arterial pressure during spinal anaesthesiain caesarean section- a clinical study. Indian J Anaesthesia. 2003;47(2): 125-128.
- NganKee W. D, Khaw K. S, Lau T. K, F. F. Ng, K. Chui, K.L. Ng. Randomizeddouble blinded comparison of Phenylephrine Vs Ephedrine for maintaining bloodpressure during spinal anaesthesia for non- elective caesarean section. Anaesthesia, 2008,63:1319-13263.