EFFICACY OF PHENYLEPHRINE INFUSION VERSES COLLOID PRELOADING IN RESOLVING HYPOTENSION DUE TO SPINAL ANAESTHESIA DURING CAESAREAN SECTION
AbstractBackground: Spinal anaesthesia causes hypotension that is countered through various methods. Phenylephrine is a vasoconstrictor and haemocoel increases the intravascular vascular volume; both have an effect in preventing this hypotension; but their comparison has not been done in local setting. Methods: Randomized control trial was conducted in month of June, 2017 at Ayub Teaching Hospital, Abbottabad. Block randomization with sealed envelopes was employed. Sample size was set at 90. Two equal groups were formed; Group A received 500 ml of haemocoel before spinal anaesthesia administration and Group B received 300µg of phenylephrine in 100ml infusion over 3 minutes. Results: An average drop of 8.2 mmHg, 9.7 mmHg and 3.1 mmHg in MAP was observed in Group A participants at 5 minutes, 10 minutes and 15 minutes respectively after spinal anaesthesia. In Group B, an average drop of 1.2mmHg was observed in first 5 minutes. MAP did not change significantly from this value throughout the monitoring period. There was a drop of 1.2 mmHg at 5 minutes in group B. After this, no further drop in blood pressure was observed. Conclusion: Phenylephrine infusion is better than haemocoel preload in preventing hypotension due to spinal anaesthesia.Keywords: phenylephrine infusion; spinal anaesthesia; Hypotension
Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27(2):89–94.
Mitra JK. Prevention of hypotension following spinal anaesthesia in caesarean section-then and now. Kathmandu Univ Med J (KUMJ) 2010;8(32):415–9.
Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001;94(5):888–906.
Wlody D. Complications of regional anesthesia in obstetrics. Clin Obstet Gynecol 2003;46(3):667–78.
O’Donoghue K. Physiological changes in pregnancy. In: Baker PN, Kenny LC, editors. Obstetrics by ten teachers. 19 ed. Hodder Arnold an Hachette UK Company, 2011; p.20–37.
Chen A, Basso O. Does low maternal blood pressure during pregnancy increase the risk of perinatal death? Epidemiology 2007;18(5):619–22.
Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology 2005;103(4):744–50.
Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006;(4):CD002251.
Rout CC, Rocke DA. Prevention of hypotension following spinal anesthesia for cesarean section. Int Anesthesiol Clin 1994;32(2):117–36.
Loubert C. Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: continuing professional development. Can J Anesth 2012;59(6):604–19.
Bajwa SJ, Kulshrestha A, Jindal R. Co-loading or pre-loading for prevention of hypotension after spinal anaesthesia! a therapeutic dilemma. Anesth Essays Res 2013;7(2):155–9.
Singh J, Ranjit S, Shrestha S, Sharma R, Marahatta SB. Effect of preloading on haemodynamic of the patient undergoing surgery under spinal anaesthesia. Kathmandu Univ Med J 2010;8(30):216–21.
Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg 2002;94(4):920–6.
Farid Z, Mushtaq R, Ashraf S. Comparative efficacy of crystalloid preloading and co-loading to prevent spinal anesthesia induced hypotension in elective caesarean section. Pak J Med Health Sci 2016;10(1):42–5.
Habib AS. A review of the impact of phenylephrine administration on maternal hemodynamics and maternal and neonatal outcomes in women undergoing cesarean delivery under spinal anesthesia. Anesth Analg 2012;114(2):377–90.
Hughes SC, Ward MG, Levinson G, Shnider SM, Wright RG, Gruenke LD, et al. Placental transfer of ephedrine does not affect neonatal outcome. Anesthesiology 1985;63(2):217–9.
Bottiger BA, Bezinover DS, Mets B, Dalal PG, Prozesky J, Ural S, et al. Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference? J Anaesthesiol Clin Pharmacol 2016;32(3):319–24.