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Srpski arhiv za celokupno lekarstvo 2020 Volume 148, Issue 3-4, Pages: 173-179
https://doi.org/10.2298/SARH190607009V
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Comparison of efficacy and safety of preemptive infusion protocols of ephedrine and phenylephrine - prevention of hypotension and effects on hemodynamic parameters during spinal anesthesia for caesarean section

Vukotić Aleksandra D. (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia)
Green David (King’s College Hospital NHS Foundation Trust, Department of Anaesthetics, Intensive Care and Pain Relief, London, UK)
Jevđić Jasna D. (University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia + Kragujevac Clinical Center, Department of Anesthesiology and Reanimation, Kragujevac, Serbia)
Vukotić Milovan R. (Banjica Institute for Orthopeadic Surgery, Department for Anesthesia, Reanimatology and Intensive Care, Belgrade, Serbia)
Petrović Nina ORCID iD icon (University of Belgrade, Vinča Institute of Nuclear Sciences, Department of Radiobiology and Molecular Genetics, Belgrade, Serbia)
Stevanović Predrag D. ORCID iD icon (Dr Dragiša Mišović - Dedinje University Clinical Hospital Center, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)

Introduction/Objective. Spinal anesthesia (SA) for cesarean section may lead to significant changes in hemodynamic parameters, especially hypotension. The aim of this study was to determine and compare the efficacy and safety of preemptive infusion protocols of the two most commonly used vasopressors, ephedrine (Group E, n = 29) and phenylephrine (Group P, n = 31) not only on prevention of hypotension but also to determine their effect on hemodynamic parameters, such as stroke volume (SV) and cardiac output (CO) using a continuous non-invasive hemodynamic monitor. Methods. The infusion of ephedrine was administered at the rate of 5 mg/min. immediately after SA. Phenylephrine was administered at an infusion rate of 25 μg/min for two minutes prior to SA. Results. In Group E, mean systolic blood pressure (SBP) and heart rate (HR) were similar to baseline. CO was higher (p < 0.001), while systemic vascular resistance (SVR) was lower than baseline (p < 0.001). In Group P, mean SBP and diastolic blood pressure (DBP) were lower than baseline, respectively (p = 0.006, p < 0.001). SBP, DBP, CO, SV, SVR, and HR were significantly different between the E and P groups (p < 0.001). Conclusion. E and P vasopressors are both effective in the prevention of hypotension during SA.

Keywords: cesarean section, spinal anesthesia, ephedrine, phenylephrine, hypotension, hemodynamic parameters