The effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes_West China Medical Journal

Authors：

LIN Yuangui ,  JIANG Xiaoqin

Department of Anesthesiology, West China Second University Hospital, Sichuan University / Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education; Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

JIANG Xiaoqin, Email: 1598862657@qq.com

Keywords：

Phenylephrine; Combined spinal and epidural anesthesia; Cesarean section

DOI：

10.7507/1002-0179.201608183

Video：

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Objective To discuss the effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. Methods A total of 50 patients scheduled for selective cesarean section under combined spinal and epidural anesthesia were selected as the study subjects between July 2015 and June 2016. They were randomly allocated into two groups with 25 in each. Group CII underwent continuous phenylephrine infusion [0.5 μg/(kg·min)] immediately after anesthesia to adjust the blood pressure, while group CON accepted single-dose phenylephrine injection (50 μg) after anesthesia when systolic pressure was lower than 90 mm Hg (1 mm Hg=0.133 kPa) or when the decrease of mean arterial pressure (MAP) was higher than 20% of the base value. The infusion of phenylephrine was stopped after the fetus was taken out. MAP, cardiac output, cardiac index (CI) at the time when the patient went into the delivery room (T₁), before anesthesia (T₂), 1 minute after anesthesia (T₃), 3 minutes after anesthesia (T₄), 10 minutes after anesthesia (T₅), and delivery (T₆) were recorded. Blood gas analysis of fetal umbilical arterial blood was carried out and neonatal Apgar score was recorded. Results Hemodynamics was more stable in group CII compared with group CON. Heart rate at T₄ and T₅, and cardiac output at T₅ and T₆ in group CON were significantly lower than those in group CII (P<0.05). The neonatal umbilical arterial blood pH value, base excess and HCO₃^－ were all significantly lower, while partial pressure of carbon dioxide was significantly higher in group CON than group CII (P<0.05). Conclusion Compared with single-dose phenylephrine injection, continuous phenylephrine infusion has more stable hemodynamics, and exert less effect on maternal and infant outcomes for patients undergoing cesarean section under combined spinal and epidural anesthesia.

Citation： LIN Yuangui, JIANG Xiaoqin. The effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes. West China Medical Journal, 2017, 32(5): 727-730. doi: 10.7507/1002-0179.201608183 Copy

1.	?Pei Z, Heinrich J, Fuertes E, et al. Cesarean delivery and risk of childhood obesity. J Pediatr, 2014, 164(5): 1068-1073.e2.
2.	Chaillet N, Dumont A, Abrahamowicz M, et al. A cluster-randomized trial to reduce cesarean delivery rates in Quebec. N Engl J Med, 2015, 372(18): 1710-1721.
3.	Gambling DR, Mclaughin KR. Ephedrine and phenylephrine use during cesarean delivery. Anesthesiology, 2010, 112(5): 1287-1288; author reply 1288-1294.
4.	Smiley RM. Ephedrine and phenylephrine use during cesarean delivery. Anesthesiology, 2010, 112(112): 1288-1294.
5.	Kuhn JC, Hauge TH, Rosseland LA, et al. Hemodynamics of phenylephrine infusionversus lower extremity compression during spinal anesthesia for cesarean delivery: a randomized, double-blind, placebo-controlled study. Anesth Analg, 2016, 122(4): 1120-1129.
6.	Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for caesarean delivery: systematic review and meta-analysis. Br J Anaesth, 2011, 107(3): 308-318.
7.	Leo S, Sng BL, Lim Y, et al. A randomized comparison of low doses of hyperbaric bupivacaine in combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg, 2009, 109(5): 1600-1605.
8.	Bouchnak M, Belhadj N, Chaaoua T, et al. Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension?. Ann Fr Anesth Reanim, 2006, 25(1): 17-19.
9.	張輝, 孟凡民, 張加強, 等. 不同劑量去氧腎上腺素靜脈注射對腰硬聯合麻醉下剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2012, 28(4): 332-334.
10.	王猛, 韓傳寶, 錢燕寧. 麻黃堿與去氧腎上腺素對腰硬聯合麻醉剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2010, 26(8): 664-666.
11.	何亞軍, 譚憲湖, 劉敬臣. 不同速率去氧腎上腺素預防腰硬聯合麻醉下行剖宮產術產婦低血壓的效果觀察. 山東醫藥, 2013, 53(17): 68-70.
12.	謝自明, 馬帆. 去氧腎上腺素和麻黃堿預防擇期剖宮產產婦術中低血壓和對胎兒代謝的影響. 寧夏醫學雜志, 2016, 38(1): 67-69.
13.	董延林, 夏國生, 葛蓮芳. 預注去氧腎上腺素或麻黃堿對腰麻下剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2015, 31(8): 777-779.
14.	劉明. 去氧腎上腺素和麻黃堿在剖宮產術腰-硬聯合阻滯麻醉中血壓管理對母嬰的影響. 中國臨床研究, 2014, 27(4): 447-448, 450.
15.	das Neves JF, Monteiro GA, de Almeida JR, et al. Phenylephrine for blood pressure control in elective cesarean section: therapeuticversus prophylactic doses. Rev Bras Anestesiol, 2010, 60(4): 391-398.

1. ?Pei Z, Heinrich J, Fuertes E, et al. Cesarean delivery and risk of childhood obesity. J Pediatr, 2014, 164(5): 1068-1073.e2.
2. Chaillet N, Dumont A, Abrahamowicz M, et al. A cluster-randomized trial to reduce cesarean delivery rates in Quebec. N Engl J Med, 2015, 372(18): 1710-1721.
3. Gambling DR, Mclaughin KR. Ephedrine and phenylephrine use during cesarean delivery. Anesthesiology, 2010, 112(5): 1287-1288; author reply 1288-1294.
4. Smiley RM. Ephedrine and phenylephrine use during cesarean delivery. Anesthesiology, 2010, 112(112): 1288-1294.
5. Kuhn JC, Hauge TH, Rosseland LA, et al. Hemodynamics of phenylephrine infusionversus lower extremity compression during spinal anesthesia for cesarean delivery: a randomized, double-blind, placebo-controlled study. Anesth Analg, 2016, 122(4): 1120-1129.
6. Arzola C, Wieczorek PM. Efficacy of low-dose bupivacaine in spinal anaesthesia for caesarean delivery: systematic review and meta-analysis. Br J Anaesth, 2011, 107(3): 308-318.
7. Leo S, Sng BL, Lim Y, et al. A randomized comparison of low doses of hyperbaric bupivacaine in combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg, 2009, 109(5): 1600-1605.
8. Bouchnak M, Belhadj N, Chaaoua T, et al. Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension?. Ann Fr Anesth Reanim, 2006, 25(1): 17-19.
9. 張輝, 孟凡民, 張加強, 等. 不同劑量去氧腎上腺素靜脈注射對腰硬聯合麻醉下剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2012, 28(4): 332-334.
10. 王猛, 韓傳寶, 錢燕寧. 麻黃堿與去氧腎上腺素對腰硬聯合麻醉剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2010, 26(8): 664-666.
11. 何亞軍, 譚憲湖, 劉敬臣. 不同速率去氧腎上腺素預防腰硬聯合麻醉下行剖宮產術產婦低血壓的效果觀察. 山東醫藥, 2013, 53(17): 68-70.
12. 謝自明, 馬帆. 去氧腎上腺素和麻黃堿預防擇期剖宮產產婦術中低血壓和對胎兒代謝的影響. 寧夏醫學雜志, 2016, 38(1): 67-69.
13. 董延林, 夏國生, 葛蓮芳. 預注去氧腎上腺素或麻黃堿對腰麻下剖宮產產婦及新生兒的影響. 臨床麻醉學雜志, 2015, 31(8): 777-779.
14. 劉明. 去氧腎上腺素和麻黃堿在剖宮產術腰-硬聯合阻滯麻醉中血壓管理對母嬰的影響. 中國臨床研究, 2014, 27(4): 447-448, 450.
15. das Neves JF, Monteiro GA, de Almeida JR, et al. Phenylephrine for blood pressure control in elective cesarean section: therapeuticversus prophylactic doses. Rev Bras Anestesiol, 2010, 60(4): 391-398.

West China Medical Journal

The effect of continuous phenylephrine infusion and single-dose phenylephrine injection on puerpera undergoing spinal and epidural combined anesthesia and the infant outcomes

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