Cargando…

Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section

BACKGROUND AND AIMS: Phenylephrine is the vasopressor of choice in spinal anaesthesia–induced maternal hypotension. However, it results in reflex bradycardia and decrease in cardiac output (CO), an effect that is perhaps less evident with the use of norepinephrine. We sought to evaluate the effect o...

Descripción completa

Detalles Bibliográficos
Autores principales: Goel, Kanika, Luthra, Neeru, Goyal, Namrata, Grewal, Anju, Taneja, Ashima
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445212/
https://www.ncbi.nlm.nih.gov/pubmed/34584283
http://dx.doi.org/10.4103/ija.IJA_185_21
_version_ 1784568604141813760
author Goel, Kanika
Luthra, Neeru
Goyal, Namrata
Grewal, Anju
Taneja, Ashima
author_facet Goel, Kanika
Luthra, Neeru
Goyal, Namrata
Grewal, Anju
Taneja, Ashima
author_sort Goel, Kanika
collection PubMed
description BACKGROUND AND AIMS: Phenylephrine is the vasopressor of choice in spinal anaesthesia–induced maternal hypotension. However, it results in reflex bradycardia and decrease in cardiac output (CO), an effect that is perhaps less evident with the use of norepinephrine. We sought to evaluate the effect of phenylephrine and norepinephrine infusion on maternal systolic blood pressure (SBP), heart rate (HR), intraoperative nausea vomiting (IONV) and fatal Apgar scores. METHODS: A randomised double-blind study was conducted on 200 American Society of Anesthesiologists (ASA) II–III parturients undergoing caesarean section under subarachnoid block (SAB) who were randomised to two groups A and B to receive variable rate, manually controlled infusions of phenylephrine and norepinephrine targeting maintenance of SBP to 100% of the baseline value. Maternal haemodynamics especially episodes of hypotension, IONV and vasopressor consumption were observed and recorded. RESULTS: A statistically significant trend of lower SBP was observed during the first 6 min following intrathecal injection in group A (P value – 0.000). Though a greater number of parturients experienced ≥1 episode of hypotension in Group A vs Group B (13% vs 9%), the difference was, however, statistically insignificant. The incidence of bradycardia was higher in group A than in group B (16% vs 1%) and was found to be statistically significant (P < 0.05). The episodes of hypertension, IONV, maternal vasopressor consumption and neonatal Apgar score were comparable among both the groups. CONCLUSION: A dilute solution of norepinephrine infusion is comparably efficacious to the current gold standard vasopressor phenylephrine in maintaining blood pressure following spinal anaesthesia for caesarean delivery, with a significantly lower incidence of bradycardia.
format Online
Article
Text
id pubmed-8445212
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Wolters Kluwer - Medknow
record_format MEDLINE/PubMed
spelling pubmed-84452122021-09-27 Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section Goel, Kanika Luthra, Neeru Goyal, Namrata Grewal, Anju Taneja, Ashima Indian J Anaesth Original Article BACKGROUND AND AIMS: Phenylephrine is the vasopressor of choice in spinal anaesthesia–induced maternal hypotension. However, it results in reflex bradycardia and decrease in cardiac output (CO), an effect that is perhaps less evident with the use of norepinephrine. We sought to evaluate the effect of phenylephrine and norepinephrine infusion on maternal systolic blood pressure (SBP), heart rate (HR), intraoperative nausea vomiting (IONV) and fatal Apgar scores. METHODS: A randomised double-blind study was conducted on 200 American Society of Anesthesiologists (ASA) II–III parturients undergoing caesarean section under subarachnoid block (SAB) who were randomised to two groups A and B to receive variable rate, manually controlled infusions of phenylephrine and norepinephrine targeting maintenance of SBP to 100% of the baseline value. Maternal haemodynamics especially episodes of hypotension, IONV and vasopressor consumption were observed and recorded. RESULTS: A statistically significant trend of lower SBP was observed during the first 6 min following intrathecal injection in group A (P value – 0.000). Though a greater number of parturients experienced ≥1 episode of hypotension in Group A vs Group B (13% vs 9%), the difference was, however, statistically insignificant. The incidence of bradycardia was higher in group A than in group B (16% vs 1%) and was found to be statistically significant (P < 0.05). The episodes of hypertension, IONV, maternal vasopressor consumption and neonatal Apgar score were comparable among both the groups. CONCLUSION: A dilute solution of norepinephrine infusion is comparably efficacious to the current gold standard vasopressor phenylephrine in maintaining blood pressure following spinal anaesthesia for caesarean delivery, with a significantly lower incidence of bradycardia. Wolters Kluwer - Medknow 2021-08 2021-08-25 /pmc/articles/PMC8445212/ /pubmed/34584283 http://dx.doi.org/10.4103/ija.IJA_185_21 Text en Copyright: © 2021 Indian Journal of Anaesthesia https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Goel, Kanika
Luthra, Neeru
Goyal, Namrata
Grewal, Anju
Taneja, Ashima
Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title_full Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title_fullStr Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title_full_unstemmed Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title_short Comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
title_sort comparison of norepinephrine and phenylephrine infusions for maintenance of haemodynamics following subarachnoid block in lower segment caeserean section
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8445212/
https://www.ncbi.nlm.nih.gov/pubmed/34584283
http://dx.doi.org/10.4103/ija.IJA_185_21
work_keys_str_mv AT goelkanika comparisonofnorepinephrineandphenylephrineinfusionsformaintenanceofhaemodynamicsfollowingsubarachnoidblockinlowersegmentcaesereansection
AT luthraneeru comparisonofnorepinephrineandphenylephrineinfusionsformaintenanceofhaemodynamicsfollowingsubarachnoidblockinlowersegmentcaesereansection
AT goyalnamrata comparisonofnorepinephrineandphenylephrineinfusionsformaintenanceofhaemodynamicsfollowingsubarachnoidblockinlowersegmentcaesereansection
AT grewalanju comparisonofnorepinephrineandphenylephrineinfusionsformaintenanceofhaemodynamicsfollowingsubarachnoidblockinlowersegmentcaesereansection
AT tanejaashima comparisonofnorepinephrineandphenylephrineinfusionsformaintenanceofhaemodynamicsfollowingsubarachnoidblockinlowersegmentcaesereansection