The use of phenylephrine to obtund oxytocin-induced hypotension and tachycardia during caesarean section |
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| Institution: | 1. Department of Anaesthesia, University of Cape Town, Cape Town, South Africa;2. Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa;1. Anesthesiology Department, “Alexandra” General Hospital of Athens, Greece;2. 1st Departement of Obstetrics & Gynecology, University of Athens Medical School, “Alexandra” General Hospital of Athens, Greece;1. Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;2. College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA;1. Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA 6009, Australia;2. Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Rd, Subiaco, WA 6008, Australia;3. Department of Women''s Anaesthesia, KK Women''s and Children''s Hospital, Singapore;4. Women and Infants Research Foundation, Perth, WA, Australia;5. Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA;1. Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt;2. Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura, Egypt |
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| Abstract: | BackgroundOxytocin causes clinically significant hypotension and tachycardia. This study examined whether prior administration of phenylephrine obtunds these unwanted haemodynamic effects.MethodsForty pregnant women undergoing elective caesarean section under spinal anaesthesia were randomised to receive either an intravenous 50 μg bolus of phenylephrine (Group P) or saline (Group S) immediately before oxytocin (3 U over 15 s). Systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate were recorded using a continuous non-invasive arterial pressure device. Baseline values were averaged for 20 s post-delivery. Between-group comparisons were made of the mean peak changes in blood pressure and heart rate, and the mean percentage changes from baseline, during the 150 s after oxytocin administration.ResultsThe mean ± SD peak percentage change in systolic blood pressure was ?16.9 ± 2% in Group P, and ?19.0 ± 1.9% in Group S and the estimated mean difference was 2.1% (95% CI ?3.5% to 7.8%; P=0.44); corresponding changes in heart rate were 13.5 ± 2.3% and 14.0 ± 1.5% and the mean estimated difference was 0.5% (95% CI ?6.0% to 5%; P=0.87). The mean percentage change from the baseline measurements during the 150 s period of measurement was greater for Group S than Group P: systolic blood pressure ?5.9% vs ?3.4% (P=0.149); diastolic blood pressure ?7.2% vs ?1.5% (P=0.014); mean arterial pressure ?6.8% vs ?1.5% (P=0.007); heart rate 2.1% vs ?2.4% (P=0.033).ConclusionIntravenous phenylephrine 50 μg immediately before 3 U oxytocin during elective caesarean section does not prevent maternal hypotension and tachycardia. |
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| Keywords: | Caesarean section Maternal haemodynamics Oxytocin Phenylephrine |
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