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ORIGINAL ARTICLE
Year : 2018  |  Volume : 16  |  Issue : 1  |  Page : 27-32

Prophylaxis or treatment of spinal hypotension during cesarean delivery: phenylephrine versus norepinephrine boluses


1 Department of Anesthesia and Intensive Care, Al-Azhar Faculty of Medicine for Male, Al-Azhar University, Cairo, Egypt
2 Department of Anesthesia and Intensive Care, Al-Azhar Faculty of Medicine for Girl, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Mofeed A Abdelmaboud
Department of Anesthesia and Intensive Care, Al-Azhar Faculty of Medicine for Male, Al-Azhar University, Cairo 12992
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AZMJ.AZMJ_31_18

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Background Vasopressors have traditionally been used for the prevention and management of neuraxial hypotension. Aim The primary outcome was to determine which is better, prophylaxis or treatment of spinal hypotension during cesarean delivery and to determine which drug is better, phenylephrine (PE) or norepinephrine (NE). The secondary outcome was to determine possible complications. Patients and methods According to the percentage degree of fall of systolic blood pressure (SBP) after spinal block, 100 full-term pregnant female patients were classified into either prophylaxis groups: received intravenous bolus of either PE 100 µg (group I) or NE 8 µg (group II) when mean arterial pressure (MAP) fell between 100 and 80% of baseline, or treatment groups: received same bolus of PE (group III) or NE (group VI) when MAP fell below 80% of baseline. Baseline and intraoperative SBP, SBP at first episode of decrease of SBP, time at first episode of decrease of SBP and response (%), incidence of hypertension, bradycardia, number of patients who required atropine, incidence of nausea, vomiting and need for antiemetic, and Apgar score at 1 and 5 min were recorded. Results The SBP at first episode of decrease of SBP was significantly lower in both treatment groups. The incidence of bradycardia was significantly higher in both PE groups but it did not occur in both NE groups (0%). The incidence of nausea and hypotension-induced nausea was significantly higher in both treatment groups than both prophylaxis groups. The Apgar score at both 1 min and 5 min was significantly lower in group III than in group I, in group IV than in group I, in group III than in group II, and in group IV than in group II. Conclusion First, spinal hypotension prophylaxis during elective cesarean section gave better results than treatment with less incidence of nausea and hypotension-induced nausea and better Apgar score at 1 and 5 min. Second, NE can be a suitable alternative to PE with no bradycardia and is readily available and less expensive.


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