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• W2895963340 abstract "INTRODUCTION:Anaesthesia to a parturient is not only unique but also requires highest degree of care because the anesthesiologist has to look after two individuals, the mother and foetus. In elective caesarean section under spinal anaesthesia hypotension has been reported in as many as 85% of patients.Hypotension during spinal anesthesia for caesarean delivery can have detrimental effects on both mother and neonate. These effects include decreased utero placental blood flow, impaired foetal oxygenation with asphyxial stress and foetal acidosis and maternal symptoms of low cardiac output such as nausea, vomiting, dizziness and decreased consciousness.Therefore there has been much attention in the literature to methods of preventing and treating hypotension in obstetric anaesthesia. Careful positioning with left uterine displacement and volume preloading with crystalloids or colloids has been used to prevent it, but these are not complete measures and vasopressor is required to correct hypotension quickly.Vasopressor like Ephedrine, Mephentermine, Phenylephrine,Metaraminol and Methoxamine are used for treating the hypotension. In this study we compare the efficacy of Ephedrine, Mephentermine and Phenylephrine in treating the hypotension for caesarean section and their undesirable side effects.AIM OF STUDY:To compare the effects of Ephedrine, Mephentermine andPhenylephrine in the management of hypotension during spinal anesthesia for cesarean section based on the following parameters:1. Efficacy of vasopressor in treating hypotension,2. Incidence of undesirable side effects,3. Effect on neonatal outcome.MATERIALS AND METHODSThis study was conducted at INSTITUTE FOR SOCIAL OBSTETRICS, GOVERNMENT KASTURBA GANDHI HOSPITAL, Triplicane, attached to MADRAS MEDICAL COLLEGE, Chennai-600005 between June 2007 to July 2007 on 90 patients undergoing elective and emergency LSCS. The study was done after getting institutional approval.Written informed consent was obtained from all the patients included in the study.Study design:This study was done in a prospective double blind randomized manner. The patients were divided into three groups of 30 each. Patients meeting the criteria were incorporated into the study. Randomization achieved by sealed envelope technique.Group 1: Patients in this group received Inj Ephedrine 6 mg IV bolus on developing hypotension.Group 11: Patients in this group received Inj Mephentermine 6 mg IV bolus on developing hypotension.Group 111: Patients in this group received Inj Phenylephrine 100 microgram IV bolus on developing hypotension.Selection of cases:Inclusion criteria:Patients in age group of 18 – 35 years of age, healthy, ASA I & II patients with singleton full term pregnancy, undergoing elective and emergency LSCS were included in the study.Exclusion criteria:1. Patients >35 years of age,2. Known hypertensive patients , patients on anti hypertensive drugs,3. Uncontrolled PIH,4. ASA III, IV patients,5. Multiple Gestation,6. Obese ( > 90 kg),7. Short stature (< 140 cm),Investigations:1. Hb%, PCV,2. Blood grouping & typing,3. BT, CT, Platelet count,4. Blood sugar, blood urea, Sr. Creatinine,5. Urine albumin, Sugar.OBSERVATION AND RESULTS:Demographic Data:All the three groups were comparable with respect to their age, height, weight, baseline systolic BP, diastolic BP, MAP, heart rate. Also the time to develop hypotension, lowest systolic BP recorded, SAB-delivery time werecomparable in the three groups and was not statistically significant. The level of sensory blockade was comparable in all the three groups and was not statistically significant.SUMMARY:This double blind prospective randomized control study was designed to evaluate the efficacy of Ephedrine, Mephentermine and Phenylephrine in treating hypotension during spinal anaesthesia for cesarean section. The incidence of undesirable side effects and neonatal outcome in terms of Apgar score were also studied.Following observations were made:1. All the three vasopressors maintained the arterial pressure effectively within 20% of baseline values.2. The mean value of heart rate was highest in Mephentermine group followed by Ephedrine and Phenylephrine groups.3. The mean values of Systolic BP, Diastolic BP and MAP were higher in Phenylephrine group followed by Mephentermine group and Ephedrine group throughout the study period.4. Phenylephrine group required fewer number of bolus doses when compared with Mephentermine and Ephedrine group.5. The heart rate generally remained low throughout the study period in Phenylephrine group and the incidence of bradycardia was more in Phenylephrine group when compared with other two groups.6. The incidences of tachycardia were same in both Ephedrine and Mephentermine groups (one case in each group). In Ephedrine group two cases developed hypertension compared with no hypertension in other two groups. The occurrence of nausea and vomiting were similar and comparable in all the three groups.7. In all the three groups no neonate had an Apgar score of less than 7 at 5th minute.CONCLUSION:In conclusion, we found that all the three vasopressors namely Ephedrine, Mephentermine and Phenylephrine are effective in IV bolus form in maintenance of maternal arterial pressure within 20% limit of baseline values, though Phenylephrine has quicker peak effect, in comparison to Ephedrine and Mephentermine and it causes reduction in heart rate, which may be advantageous in patients in whom tachycardia is undesirable. All the three vasopressor had no significant adverse effects on neonatal outcome." @default.
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• W2895963340 date "2008-03-01" @default.
• W2895963340 modified "2023-09-27" @default.
• W2895963340 title "Comparision of Bolus Ephedrine, Mephentermine and Pphenylephrine for the management of Hypotension during Spinal Anaesthesia for Caesarean Section: A Clinical study" @default.
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