Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery
Background Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in...
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| Format: | Article |
| Language: | English |
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Korean Society of Anesthesiologists
2020-01-01
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| Series: | Anesthesia and Pain Medicine |
| Subjects: | |
| Online Access: | http://www.anesth-pain-med.org/upload/pdf/APM-15-053.pdf |
| _version_ | 1827946215608680448 |
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| author | Woo Jin Cho Seung Yeon Cho Ae-Ryoung Lee |
| author_facet | Woo Jin Cho Seung Yeon Cho Ae-Ryoung Lee |
| author_sort | Woo Jin Cho |
| collection | DOAJ |
| description | Background Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in this setting, using intermittent bolus doses to treat spinal anesthesia-induced hypotension. Methods A total of 56 parturients consenting to spinal anesthesia for elective cesarean delivery were randomly assigned to phenylephrine (100 μg/ml) or norepinephrine (5 μg/ml) intermittent bolus dosing. The primary study outcome was maternal normalized CO, examining and other hemodynamic variables, maternal side effects, and fetal outcomes secondarily. Results In terms of systolic blood pressure and HR, there were significant within-group differences over time (P < 0.001 and P < 0.001, respectively). Normalized CO and stroke volume (SV) also showed significant differences between groups (P < 0.001 and P = 0.002, respectively). In the phenylephrine group, normalized CO and SV declined (relative to baseline values) by as much as 13% and 9%, respectively; whereas in the norepinephrine group, normalized CO did not differ significantly from baseline, and SV increased up to 5% (relative to baseline). Normalized total peripheral resistance likewise displayed significant within-group differences over time (P < 0.001). Conclusions During elective cesarean delivery, intermittent bolus doses of norepinephrine proved effective for treating spinal anesthesia-induced hypotension, while maintaining CO and SV. No maternal complications or fetal effects were evident. |
| first_indexed | 2024-03-13T10:54:32Z |
| format | Article |
| id | doaj.art-97665446cd0f4f108a0e63d8758dc084 |
| institution | Directory Open Access Journal |
| issn | 1975-5171 2383-7977 |
| language | English |
| last_indexed | 2024-03-13T10:54:32Z |
| publishDate | 2020-01-01 |
| publisher | Korean Society of Anesthesiologists |
| record_format | Article |
| series | Anesthesia and Pain Medicine |
| spelling | doaj.art-97665446cd0f4f108a0e63d8758dc0842023-05-17T05:28:54ZengKorean Society of AnesthesiologistsAnesthesia and Pain Medicine1975-51712383-79772020-01-01151536010.17085/apm.2020.15.1.53980Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean deliveryWoo Jin Cho0Seung Yeon Cho1Ae-Ryoung Lee2Department of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, KoreaDepartment of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, KoreaDepartment of Anesthesiology and Pain Medicine, Jeju National University Hospital, Jeju, KoreaBackground Norepinephrine, a potent α-adrenergic agonist with β-adrenergic effects, has recently emerged as a potential alternative to phenylephrine that does not lower cardiac output (CO) and heart rate (HR) during cesarean deliveries. We examined the systemic hemodynamic effects of both agents in this setting, using intermittent bolus doses to treat spinal anesthesia-induced hypotension. Methods A total of 56 parturients consenting to spinal anesthesia for elective cesarean delivery were randomly assigned to phenylephrine (100 μg/ml) or norepinephrine (5 μg/ml) intermittent bolus dosing. The primary study outcome was maternal normalized CO, examining and other hemodynamic variables, maternal side effects, and fetal outcomes secondarily. Results In terms of systolic blood pressure and HR, there were significant within-group differences over time (P < 0.001 and P < 0.001, respectively). Normalized CO and stroke volume (SV) also showed significant differences between groups (P < 0.001 and P = 0.002, respectively). In the phenylephrine group, normalized CO and SV declined (relative to baseline values) by as much as 13% and 9%, respectively; whereas in the norepinephrine group, normalized CO did not differ significantly from baseline, and SV increased up to 5% (relative to baseline). Normalized total peripheral resistance likewise displayed significant within-group differences over time (P < 0.001). Conclusions During elective cesarean delivery, intermittent bolus doses of norepinephrine proved effective for treating spinal anesthesia-induced hypotension, while maintaining CO and SV. No maternal complications or fetal effects were evident.http://www.anesth-pain-med.org/upload/pdf/APM-15-053.pdfcesarean sectionnorepinephrinephenylephrine |
| spellingShingle | Woo Jin Cho Seung Yeon Cho Ae-Ryoung Lee Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery Anesthesia and Pain Medicine cesarean section norepinephrine phenylephrine |
| title | Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| title_full | Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| title_fullStr | Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| title_full_unstemmed | Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| title_short | Systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| title_sort | systemic hemodynamic effects of norepinephrine versus phenylephrine in intermittent bolus doses during spinal anesthesia for cesarean delivery |
| topic | cesarean section norepinephrine phenylephrine |
| url | http://www.anesth-pain-med.org/upload/pdf/APM-15-053.pdf |
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