Nurse Anesthesia

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https://hdl.handle.net/20.500.11888/3201

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Browsing Nurse Anesthesia by Author "Dr. Aysar Al-Bargouthi"

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    Prophylactic Ephedrine versus Phenylephrine for Preventing Maternal Hypotension in Women Undergoing Spinal Anesthesia for Cesarean Section
    (2016) Qussai Sami Ahmad Ussbah; Dr. Aidah Alkaissi; Dr. Aysar Al-Bargouthi
    This study was presented in the 6th Palestinian Forum for Medical Research (PFMR), Biomedical Research Symposium April 9th, 2016. Bethlehem University, Palestine. This study received an award from the conference for Scientific Excellence Background Hypotension during spinal anesthesia for cesarean section is secondary to the sympathetic blockade and aorto-caval compression by the uterus and it can be deleterious to both the fetus and the mother. Ephedrine and phenylephrine improve venous return after sympathetic blockade during the spinal block. Aims The aims of the present study are to compare the efficacy of ephedrine and phenylephrine in the prevention and treatment of maternal hypotension during spinal block, to evaluate the side effects of ephedrine and phenylephrine, and to assess fetal changes as measured by Apgar scores. Methods Fifty five women, American Society of anesthesiologist (ASA) Grade I and II, undergoing spinal anesthesia with Bupivacaine and Fentanyl for cesarean section were randomly divided into two groups to receive prophylactic ephedrine (n = 27, dose = 10 mg, i.v.) or Phenylephrine (n = 28, dose = 80 µg, i.v.) immediately at the time of providing the subarachnoid block. Mean (SD) age of Ephedrine group was 30.48 ± 5.5 vs. the Phenylephrine group, which was 31.64 ± 3.3. Hypotension was defined as a decrease in systolic arterial pressure of >20% from baseline values and was treated with bolus administration of the vasopressors at 50% of the initial dose. Maternal arterial pressure (BP) and heart rate (HR) were measured every 3 minutes by automated oscillometry. Ringer's lactate (RL) solution (20 ml/kg) was infused 30 minutes before spinal injection for all participants. Vital signs (blood pressure, heart rate, and arterial oxygen saturation) were recorded throughout the surgery. Maternal and neonatal perioperative complications were also controlled and recorded. The incidence of hypotension, reactive hypertension, bradycardia, tachycardia, nausea and vomiting, and Apgar scores on the 1st and 5th minutes were evaluated. Results There was an insignificant difference in demographic data between the groups. The mean (±SD) dose of ephedrine used was 19.81 mg (±5.46) and phenylephrine was 125.71 µg (±35.64). Changes in systolic and diastolic pressure were comparable in the two groups. There were significant differences in the incidence of reactive hypertension episodes (Ephedrine group: 48 (14.5%) vs. Phenylephrine group: 26 (7.7%) P < 0.005). There were no differences in the incidence of bradycardia ( Ephedrine group: 3(11.1%) vs. Phenylephrine group: 6 (21.4%) P > 0.301). There were significant differences in the incidence of nausea and vomiting (Ephedrine group: 10 (37%) vs. Phenylephrine group: 3 (10.7%); P> 0.018). There were no significant differences in the incidence of hypotension, with an incidence of 18(66.7%) in the Ephedrine group and 17(60.7%) (P <0.646) in the Phenylephrine group. Maternal arrhythmias were more common in the Ephedrine group at 10(37%) than in the Phenylephrine group at 7 (25%), but the difference is not significant (P=0.334).Additionally, maternal restlessness was more common in the Ephedrine group:8 (30.8%) than the Phenylephrine group: 3 (10.7%), but with an insignificant difference (P=0.068). Differences in the Apgar score in the 1st and 5th minute were not observed. Number of patients who required rescue dose in the Ephedrine group was 24 (88.9%), which was significantly higher than the Phenylephrine group at 20 (71.4%), P < 0.005). There are significant differences in the number of rescue doses of the two drugs. In the Phenylephrine group there was only one patient (3.6%) that had the rescue dose 3 times, and for the Ephedrine group there were 9 patients (33.3%) that had the rescue dose 3 times each, (P = 0.033). Conclusion We conclude from this study that phenylephrine 80μg has a similar vasopressor effect to that of ephedrine 10 mg for the prevention or treatment of maternal hypotension during spinal anesthesia for elective cesarean section, and that there is no difference in neonatal clinical outcomes as measured by the Apgar score. The applicability of the results is limited to healthy women with term fetuses. The clinical significance of bradycardia, reactive hypertension and intraoperative nausea and vomiting should not be overlooked. Giving Phenylephrine immediately at the time of providing the subarachnoid block is superior to ephedrine to reduce reactive hypertension, nausea, vomiting and requirements for vasopressors rescue medication. The results of this study support the use of phenylephrine for the maintenance of maternal arterial pressure during spinal anesthesia for elective cesarean section. Nurse Anesthetist Implications In view of maternal complications, the most important and noticeable complication was brief bradycardia (reflex bradycardia), which was transient and only occurred in a few cases (HR<60 per minute) that needed treatment with 0.5 mg intravenous Atropine based on policies and procedures for anesthesia clinic supervised by an anesthesiologist. Nausea and vomiting that responded rapidly to antiemetic medication was slightly high in the ephedrine group. None of the observed complications were serious enough to have a significant impact on either the mothers or newborns according to the Apgar score. Keywords: phenylephrine, ephedrine, spinal anesthesia, maternal hypotension, cesarean section.