Prophylactic phenylephrine - ephedrine combination therapy for maternal hypotension during spinal anaesthesia: comparative study

The study was designed to evaluate the efficacy of three different regimens for prophylactic treatment of hypotension during spinal anaesthesia for elective cesarean section. Thirty-six parturients, 21-32 years old, ASA I or II and term singleton pregnancy were randomized to one of three groups receiving, preload 1.5 L Ringer's lactate solution [Fluid group] [F group], ephedrine I.V infusion 2 mg/min. [Ephedrine group] [E group], or I.V infusion 2 mg/min ephedrine plus 10 micro g/min. phenylephrine [Ephedrine + phenylephrine group [E + P group]. Maternal systolic blood pressure and heart rate were measured at frequent intervals. Hypotension defined as systolic blood pressure decrease >/= 20% from baseline blood pressure. We found that hypotension occurred less frequently in [E + P] group than in [F or E] groups 35% versus 73% and 77% respectively, supplemental ephedrine requirement and nausea scores [0 - 3] were less in the [E + P] group. Neonatal venous and arterial pH values were significantly higher in [E + P] group. Apgar scores were similarly good in the three groups. On conclusion, the incidence of hypotension during spinal anaesthesia for elective caesarean section delivery was significantly lower in phenylephrine ephedrine combination than in ephedrine infusion alone or crystalloid preload

Arterial to end tidal carbon dioxide pressure gradient during laparoscopic surgery: is it affected by obesity?

In this study changes in arterial to end tidal carbon dioxide pressure difference [PaCO[2] P[E] Co[2]] were determined in 40 ASA I and II female patients of different body weights undergoing laparoscopic surgery. They were classified into 4 equal groups, 10 patients each, according to their body weights using Broca index for obesity. Samples for measurement of arterial Co[2] tension were obtained before, during, after insufflation and before extubation. Our results showed a non significant changes in PaCo[2]-P[ET] Co[2] gradient in patients with body weight up to 60% greater than ideal weight during all phases of measurements while a high significant differences were recorded in obese patients of>60% greater than ideal weight during and after insufflation. End tidal Co[2] value have been found to be reliable in obese patients up to 60% greater than ideal weight but unreliable in obese patients of >60% greater than ideal weight. We concluded that arterial CO[2] tension should be considered in those patients to avoid hypercarbia during laparoscopy