Hemodynamic effects during spinal anesthesia for elective cesarean delivery

Patient Population
Cesarean.

LiDCO Monitor
LiDCOplus.

Trial Design
Prospective, randomised and double-blind among 40 patients.

Outcome Impact
Bolus phenylephrine reduced maternal CO and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery.

PURPOSE
The purpose of this study was to compare the effects of bolus phenylephrine and ephedrine on maternal cardiac output.

MATERIALS AND METHODS
40 healthy patients scheduled for elective Cesarean delivery under spinal anesthesia were randomised to the two study arms. Both pulse wave form analysis and transthoracic bioimpedance changes were used to estimate SV in each patient.

RESULTS
Mean CO and maximum absolute response in CO were significantly lower during the 150 s after phenylephrine administration than after ephedrine (6.2 vs. 8.1 l/min, P = 0.001, and 5.2 vs. 9.0 l/min, P = 0.0001, respectively for pulse wave form analysis, and 5.2 vs. 6.3 l/min, P = 0.01 and 4.5 vs. 6.7 l/min, P = 0.0001, respectively for bioimpedance changes).

CONCLUSIONS
Bolus phenylephrine reduced maternal CO and decreased CO when compared with ephedrine during elective spinal anesthesia for Cesarean delivery.

Dyer RA, Reed AR, van Dyk D, Arcache MT et al. Hemodynamic Effects of Ephedrine, Phenylephrine, and the Coadministration of Phenylephrine with Oxytocin during Spinal Anesthesia for Elective Cesarean Delivery. Anesthesiology. 2009;111:753–65.

“During spinal anesthesia (SA), hemodynamic changes were characterised by a reduction in SVR and a partial compensatory increase in CO. This suggests that low-dose phenylephrine, insufficient to cause marked MAP increases above baseline associated with sinus bradycardia, may be the most appropriate intervention for the initial management of hypotension in most cases to restore SVR and CO to baseline levels.”

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