A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise

R. A. Dyer*, A. Emmanuel, S. C. Adams, C. J. Lombard, M. J. Arcache, A. Vorster, C. A. Wong, Nicole Higgins, A. R. Reed, M. F. James, Y. Joolay, S. Schulein, D. van Dyk

*Corresponding author for this work

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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 (7.5–15 mg) or phenylephrine (50–100 µg), 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 <7 or with a pH <7.2. 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.

Original languageEnglish (US)
Pages (from-to)23-31
Number of pages9
JournalInternational Journal of Obstetric Anesthesia
Volume33
DOIs
StatePublished - Feb 1 2018

Fingerprint

Ephedrine
Phenylephrine
Umbilicus
Pre-Eclampsia
Hypotension
Apgar Score
Lactic Acid
Fetal Heart
Umbilical Arteries
Acidosis
Newborn Infant
Oxygen
Blood Pressure
Acids

Keywords

  • Ephedrine
  • Fetal compromise
  • Phenylephrine
  • Preeclampsia
  • Spinal hypotension
  • Vasopressor

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Anesthesiology and Pain Medicine

Cite this

Dyer, R. A. ; Emmanuel, A. ; Adams, S. C. ; Lombard, C. J. ; Arcache, M. J. ; Vorster, A. ; Wong, C. A. ; Higgins, Nicole ; Reed, A. R. ; James, M. F. ; Joolay, Y. ; Schulein, S. ; van Dyk, D. / A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. In: International Journal of Obstetric Anesthesia. 2018 ; Vol. 33. pp. 23-31.
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abstract = "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 (7.5–15 mg) or phenylephrine (50–100 µg), 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 <7 or with a pH <7.2. 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.",
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A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise. / Dyer, R. A.; Emmanuel, A.; Adams, S. C.; Lombard, C. J.; Arcache, M. J.; Vorster, A.; Wong, C. A.; Higgins, Nicole; Reed, A. R.; James, M. F.; Joolay, Y.; Schulein, S.; van Dyk, D.

In: International Journal of Obstetric Anesthesia, Vol. 33, 01.02.2018, p. 23-31.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise

AU - Dyer, R. A.

AU - Emmanuel, A.

AU - Adams, S. C.

AU - Lombard, C. J.

AU - Arcache, M. J.

AU - Vorster, A.

AU - Wong, C. A.

AU - Higgins, Nicole

AU - Reed, A. R.

AU - James, M. F.

AU - Joolay, Y.

AU - Schulein, S.

AU - van Dyk, D.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - 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 (7.5–15 mg) or phenylephrine (50–100 µg), 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 <7 or with a pH <7.2. 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.

AB - 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 (7.5–15 mg) or phenylephrine (50–100 µg), 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 <7 or with a pH <7.2. 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.

KW - Ephedrine

KW - Fetal compromise

KW - Phenylephrine

KW - Preeclampsia

KW - Spinal hypotension

KW - Vasopressor

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