Comparison of maternal and fetal effects of ephedrine, phenylephrine, and combination infusion during spinal anesthesia for cesarean delivery

ABSTRACT

BACKGROUND: Hypotension following spinal anesthesia for cesarean delivery can produce adverse maternal and neonatal effects. Single treatment with ephedrine does not prevent spinal anesthesiainduced hypotension and phenylephrine alone induces severe bradycardia. However, the combined treatment of phenylephrine with ephedrine as an infusion was observed to be effective without bradycardia. METHODS: Thirty-two term parturients were randomized into three groups to receive ephedrine, phenylephrine or combination infusion (group E, group P and group EP, respectively) starting with spinal anesthesia. Hemodynamic parameters, such as SBP, PR, CI, SVRI, SVI, were measured before and until 15 min after spinal anesthesia. Rescue boluses for hypotension comprised of phenylephrine 100microg. RESULTS: There were no statistically significant differences in all hemodynamic parameters among three groups. However, 1 min Apgar score in the group E was significant lower than P group (P = 0.008). Nausea & vomiting scores, total fluid intake, phenylephrine rescues, umbilical vein pH, and 5 min Apgar scores did not show significant differences. CONCLUSIONS: Three methods are all effective to prevent hypotension following spinal anesthesia for cesarean section. However, although there was no fetal acidosis, 1 min Apgar score of ephedrine group was significantly lower than that of phenylephrine alone group.