Prophylactic Bolus & Infusion of Phenylephrine & Ephedrine for Maintaining Maternal Hemodynamics in Caesarean Section under Spinal Anaesthesia.

Dr. G. H. Megha; Dr. S. Balabhaskar

Volume : III, Issue : VI, June - 2014

Prophylactic Bolus & Infusion of Phenylephrine & Ephedrine for Maintaining Maternal Hemodynamics in Caesarean Section under Spinal Anaesthesia.

Dr. G. H. Megha, Dr. S. Balabhaskar

Abstract :

BACKGROUND AND OBJECTIVES: Spinal anaesthesia is the anaesthetic technique of choice in caesarean section due to maternal & fetal advantages. Hypotension is the most common intraoperative complication associated with SAB. Uncorrected,it is detrimental to mother as well as fetus. Hence, the present study was undertaken using prophylactic bolus followed infusion doses of ephedrine and phenylephrine , hemodynamics monitored and side effects noted. MATERIAL & METHODS:After ethical committee clearance & written consent,100 pregnant women posted for elective /emergency caesarean section under SAB were randomly allotted into group E & group P, to receive : 20μg bolus phenylephrine iv immediately after spinal anaesthesia,followed by 10 μg/min infusion (gr.P) throughout the surgery or 6mg bolus ephedrine iv immediately after spinal anaesthesia,followed by 0.1 mg/min infusion (gr.E),throughout the surgery.Other preoperative,intra operative and post operative management were kept uniform in both groups. Hemodynamics,Uterine tone,uterine bleeding and Neonatal monitoring (APGAR scoring) were monitored and assessed during study period. Hypotension was treated with rescue dose i,e; bolus drug of the respective group. Bradycardia was treated with inj.atropine.Patients were followed up post-operatively for possible adverse effects. Results: Results were compiled & compared b/n the 2 groups & analyzed statstically. Maternal arterial blood pressure was well maintained in both the groups i,e; overall there was no statstically significant difference (p=0.832) GroupE individuals showed stable systolic arterial pressure compared to groupP. Incidence of adycardia was nil in groupE, whereas it was 24% in group P requiring treatment with inj. atropine . Uterine tone & uterine bleeding were comparable b/n the two groups. Conclusion: Thepresent study, comp� the efficacy of prophylactic bolus followed by infusion of ephedrine & phenylephrine for caesarean sections shows that Ephedrine prophylaxis is associated with better overall maintenance of hemodynamics. The incidence of adycardia was more with phenylephrine .There were no major effects on uterine tone / uterine bleeding/ APGAR score in both groups.