Апстракт
Hypotension is a major concern of the anaesthetists whenever subarachnoid block is performed especially in obstetric patients. Vasopressors have been shown to be more effective at limiting spinal hypotension than other treatment of hypotension like preloading and left uterine displacement. The aim of the study is to compare the effect of bolus intravenous Ephedrine with Phenylephrine for the maintenance of arterial blood pressure during elective caesarean section under spinal anaesthesia. This was a randomized, double blind, controlled study of sixty two healthy parturients American Society of Anesthesiologists’ (ASA) status 1 and 2 at term with singleton pregnancy who consented to subarachnoid block at University College Hospital, Ibadan, Nigeria. The parturients were preloaded with 10ml per kg of crystalloid before the induction of spinal anaesthesia with injection of 2.5ml of 0.5% hyperbaric Bupivacaine at L3/L4 levels. Ephedrine 5mg group A; n=31) or phenylephrine 100ug (group B; n=31) was given for the maintenance of arterial blood pressure. Results showed that the incidence of hypotension in the 62 patients was 24.2%. Both vasopressors effectively restored both the systolic and the diastolic blood pressure. There was significant difference in heart rate between the two groups. Nausea occurred in both groups and was found in hypotensive patients, no patient vomited during the procedure. The mean APGAR Scores were similar for the two groups; no baby had Apgar score of < 8 in either group. We concluded that phenylephrine is safe and can be used as effectively as Ephedrine. Its administration results in higher blood pressure than Ephedrine in parturients undergoing Caesarean Section under spinal
anaesthesia.
Keywords: Hypotension, ephedrine, phenylephrine, caesarean section, subarachnoid block
Résumé
Hypotension est une probléme majeur aux anesthésistes lorrsque le blocus de la subarachnoide est performée spéciallement aux patients obstétriques. Les médicaments vasopresseurrs ont demontrés ayant plus d’efficacité pour limiter l’hypotension épiniere qu’autres traitements de l hypotension comme le déplacement de l uterine gauche et le deplacemnet de l’oreillette. Le
but de cette étude etait de comparer l’effet de la dose intraveneuse d’Ephedrine plus de Phenylephrine pour la maintenance de la pression artérielle sanguine durant la section caesaréane sous anesthesie epiniere. Cette étude était au harzard, controllée et doublement aveuglée sur soixante deux anesthésiologistes de la societé Americaine (ASA) de statut 1 et 2 a terme avec de grosesse singleton qui ont accepte le blocus subarachnoid au Centre universitaire Hospitaliere d Ibadan, Nigeria. Les patients recevaient 10ml par kg de crystalloide avant l’ induction de l anaesthesie epiniere avec injection de 2.5ml de 0.5% de bupivaciane hyperbarique au niveau de L3/L4. Ephedrine 5mg groupe A; n=31) ou phenylephrine 100ug (groupe B; n=31) etait administre pour maintenir la pression sanguine arterielle. Les resultats montraient que l incidence de l’hypertension chez 62 patients etait de 24.2%. les medicaments vasopresseurs restoraient effectivement les pressiosnsystolique et diastolique. Il y avait une difference significative entre la fréquence cardiaque chez les deux groupes. La nausee etait commune chez les deux groupes etchez les patients hypotensifs, aucun des patients vomissait durant la procédure. La moyenne APGAR resultats etaient de semblable aux deux groupes; aucun des bebes avaientle resultat de l’Apgar< 8 chez ces groupes. Nous conluons que la phenylephrine estbonne et peut etre utilisée effectivementcomme Ephedrine. Le résultat de son administration chez les patients avec une presion sanguine elevee que l Ephedrine dans la section CaesareanSection sous anesthésie epiniere est demontrée.
Correspondence: Dr. T.A. Adigun, Department of Anaesthesia, University College Hospital, PMB 5116, Ibadan, Nigeria. E-mail: tonitomi2005@yahoo.co.uk
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