Department of anaesthesia and critical care medicine, Cairo university, Cairo, Egypt.
Department of obstetrics and gynaecology, Cairo university, Cairo, Egypt.
Anaesth Crit Care Pain Med. 2019 Dec;38(6):601-607. doi: 10.1016/j.accpm.2019.03.005. Epub 2019 Mar 30.
Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery.
A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes.
One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups.
When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine.
椎管内麻醉下剖宫产时，预防性血管加压药是基本的。本研究的目的是比较在剖宫产期间以不同输注率使用去氧肾上腺素和去甲肾上腺素的效果和安全性。
一项随机、双盲、对照试验纳入了计划在椎管内麻醉下择期行剖宫产的产妇。参与者被分为两组：去甲肾上腺素组（n=60）和去氧肾上腺素组（n=63）。两组产妇在椎管阻滞后以 0.05μg/kg/min 和 0.75μg/kg/min 的起始速率分别接受预防性血管加压药。血管加压药输注率根据产妇的收缩压手动调整。根据椎管内麻醉后低血压的发生率（主要结局）、心动过缓的发生率、反应性高血压的发生率、收缩压、心率、需要使用升压药的次数、医生干预的次数以及新生儿结局比较两组。
123 名产妇最终进入分析。两组在椎管内麻醉后低血压的发生率（32%与 30%，P=0.8）方面相似。去甲肾上腺素组医生干预的次数较低。去甲肾上腺素组心动过缓的发生率和反应性高血压的发生率可能较低，但无统计学意义（13%与 21%，P=0.3）和（12%与 24%，P=0.1）。两组升压药的使用次数和新生儿结局相似。
在手动调整输注的情况下，去甲肾上腺素可有效地维持产妇在椎管内麻醉下剖宫产时的收缩压，与去氧肾上腺素相比，医生干预的次数更少，可能发生反应性高血压和心动过缓的概率更低。
