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Effect of prophylactic phenylephrine and ephedrine added to the co-loading solution on maternal hypotension, nausea and vomiting in patients undergoing caesarean section in a remote Indian Island

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Original Article

Author Details : Narayanan Rajaram*, Habib Md Reazaul Karim, Mridul Dhar, Anilkumar Narayan, Avinash Prakash

Volume : 7, Issue : 1, Year : 2020

Article Page : 158-165

https://doi.org/10.18231/j.ijca.2020.028

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Abstract

Introduction and Objectives: Hypotension after spinal anaesthesia (SA) for a cesarean section may
sometimes lead to significant consequences in mother and may also lead to a compromise in neonatal
outcome. The objective of this study was to compare the effects of prophylactic Ephedrine and
Phenylephrine to prevent hypotension, nausea, and vomiting, along with the possible changes in fetal
outcome.
Materials and Methods: After approval from the institute and with informed consent, 100 parturients
undergoing cesarean section under SA, and who satisfied the inclusion criteria were divided into two
groups. All patients received 10 mg of 0.5% Bupivacaine heavy for SA, and the drug was injected at the
L3-4 level. All parturients were co-loaded with Ringer’s lactate (RL), and either 100mcg Phenylephrine
or 6mg Ephedrine was added in the RL solution. Occurrences of maternal hypotension, nausea, vomiting,
and APGAR score for neonate were noted and compared.
Results: Phenylephrine group had a significant reduction in the incidence of hypotension. However, it
did not translate into any significant reduction in the incidence of nausea or vomiting. There were also
significant differences in the APGAR scores of the neonate in 1 and 10 minutes; Phenylephrine group had
a better outcome as compared to Ephedrine group.
Conclusion: Prophylactic Phenylephrine 100 mcg added to co-loading crystalloid prevents maternal
hypotension significantly more than prophylactic Ephedrine 6 mg. The fetal outcome in terms of APGAR
score was also better in the Phenylephrine group. However, there was no difference in the maternal heart
rate, nausea, and vomiting among the groups.

Keywords: Phenyl ephrine, Ephedrine, Spinal hypotension, Cesarean section.

How to cite : Rajaram N, Karim H M R, Dhar M, Narayan A, Prakash A, Effect of prophylactic phenylephrine and ephedrine added to the co-loading solution on maternal hypotension, nausea and vomiting in patients undergoing caesarean section in a remote Indian Island. Indian J Clin Anaesth 2020;7(1):158-165

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