Singh Dheer, Yadav Jay Brijesh Singh, Singh Amit K, Rai Mrityunjay K
Anesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, IND.
Cureus. 2023 Jul 31;15(7):e42713. doi: 10.7759/cureus.42713. eCollection 2023 Jul.
Maternal hypotension is a common complication of spinal anesthesia in cesarean section and requires immediate intervention. Phenylephrine is most commonly used as a vasopressor agent for the treatment of hypotension due to subarachnoid block. Our aim was to compare the bolus dose of 50 µg of phenylephrine with a fixed infusion at 50 µg.min of phenylephrine for maintaining arterial blood pressure during cesarean delivery.
This was a prospective, randomized comparative study. One hundred normotensive pregnant females aged 18-35 years, body mass index 18-29kg.m, American Society of Anesthesiologists (ASA) physical status classification II scheduled to undergo cesarean section (elective/emergency) under spinal anesthesia were randomly divided into two groups of 50 each. Group PB received a bolus dose of phenylephrine 50 µg after they developed hypotension i.e., a decrease in systolic blood pressure (SBP) ≥ 20% from the baseline. Similarly, patients in Group PI were administered prophylactic infusion using a syringe pump of phenylephrine 50 µg.min, started just after the administration of subarachnoid block. The phenylephrine infusion was continued either till the delivery of the baby or when SBP rises >20% above the baseline. Parameters like blood pressure, heart rate, and peripheral oxygen saturation were recorded. After the delivery of the baby, the neonatal APGAR score was assessed at one minute and five minutes.
Demographic data were comparable in terms of demographic profile, duration of surgery, and ASA physical status classification between the groups. The heart rate was higher in Group PB compared to Group PI throughout the monitoring period (P<0.001). The fall in mean blood pressure was more in Group PB compared to Group PI till 18 minutes of surgery and was statistically significant (P<0.05). After 18 minutes of surgery, mean blood pressure stabilized and was comparable between the groups. Other variables like APGAR score at one minute and five minutes were comparable between the groups. Bradycardia and hypertension were more common in Group PI whereas hypotension, nausea, and vomiting were more common in group PB.
We concluded that during cesarean section under spinal anesthesia, phenylephrine infusion provides better hemodynamic stability and APGAR score during the perioperative period.
产妇低血压是剖宫产脊髓麻醉的常见并发症，需要立即干预。去氧肾上腺素是治疗蛛网膜下腔阻滞所致低血压最常用的血管升压药。我们的目的是比较50μg去氧肾上腺素推注剂量与50μg/分钟的去氧肾上腺素固定输注量在剖宫产术中维持动脉血压的效果。
这是一项前瞻性随机对照研究。100例年龄在18 - 35岁、体重指数为18 - 29kg/m²、美国麻醉医师协会（ASA）身体状况分级为II级、计划在脊髓麻醉下行剖宫产术（择期/急诊）的血压正常孕妇被随机分为两组，每组50例。PB组在出现低血压后即收缩压（SBP）较基线下降≥20%时给予50μg去氧肾上腺素推注剂量。同样，PI组患者在蛛网膜下腔阻滞给药后立即使用注射泵以50μg/分钟的速度预防性输注去氧肾上腺素。去氧肾上腺素输注持续至婴儿娩出或SBP升至高于基线20%以上时。记录血压、心率和外周血氧饱和度等参数。婴儿娩出后，在1分钟和5分钟时评估新生儿阿氏评分。
两组在人口统计学特征、手术时间和ASA身体状况分级方面的人口学数据具有可比性。在整个监测期内，PB组的心率高于PI组（P<0.001）。直到手术18分钟时，PB组平均血压的下降幅度大于PI组，且具有统计学意义（P<0.05）。手术18分钟后，平均血压稳定，两组之间具有可比性。其他变量如1分钟和5分钟时的阿氏评分在两组之间具有可比性。心动过缓和高血压在PI组更常见，而低血压、恶心和呕吐在PB组更常见。
我们得出结论，在脊髓麻醉下行剖宫产术期间，输注去氧肾上腺素在围手术期能提供更好的血流动力学稳定性和阿氏评分。
