The effect of colloid co-hydration on the use of phenylephrine and hemodynamics during low-dose combined spinal-epidural anesthesia for cesarean delivery.
10.4097/kjae.2008.55.6.685
- Author:
Suk Young LEE
1
;
Duck Hwan CHOI
;
Hyo Won PARK
Author Information
1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dhchoi@skku.edu
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
cesarean section;
colloid co-hydration;
combined spinal-epidural anesthesia;
hypotension;
phenylephrine
- MeSH:
Anesthesia;
Blood Pressure;
Bradycardia;
Bupivacaine;
Cesarean Section;
Colloids;
Ephedrine;
Female;
Fentanyl;
Heart Rate;
Hemodynamics;
Hypertension;
Hypotension;
Incidence;
Injections, Spinal;
Nausea;
Obstetrics;
Phenylephrine;
Pregnancy;
Starch;
Vomiting
- From:Korean Journal of Anesthesiology
2008;55(6):685-690
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Ephedrine has been recommended as the best vasopressor in obstetrics. But, recent clinical evidences show the possibility that phenylephrine has become more pertinent as a primary vasopressor. We think a phenylephrine infusion with colloid co-hydration will be more useful in maintaining baseline blood pressure in combined spinal-epidural anesthesia (CSEA) for cesarean section. METHODS: CSEA was performed using 6 mg bupivacaine and 20microgram fentanyl as a spinal and 10 ml of 0.25% levobupivacaine as an epidural in randomized, colloid co-hydration (hydroxyethl starch, HES 500 ml) (group C, n = 34) or no colloid co-hydration (group N, n=34) parturients scheduled to undergo cesarean delivery. After an infusion of 100microgram phenylephrine following the spinal injection, phenylephrine was intermittently infused using a PCA-pump to maintain the baseline blood pressure (BP). Systolic BP and heart rate (HR) were checked and total phenylephrine amount was measured. Nausea and vomiting and fetal umbilical pH/base excess (BE) were also investigated. RESULTS: There was a lower incidence of bradycardia in the C group compared with the N group (5.9% vs. 32.4%, p = 0.014), and total phenylephrine consumption was less in the C group (400microgram vs. 500microgram, p = 0.019). The incidence of reactive hypertension (11.8% vs. 55.9%, p < 0.001), and the hypotension (0% vs. 11.8%, p = 0.114) were lower in the C group, too. The others were comparable in both groups. CONCLUSIONS: Colloid co-hydration was effective in reducing the phenylephrine use and the incidences of abnormal hemodynamics such as hypotension, bradycardia and hypertension in low-dose CSEA for cesarean delivery.
