Randomized Double-blinded Comparison of Norepinephrine and Phenylephrine for Maintenance of Blood Pressure during Spinal Anesthesia for Cesarean Delivery

BACKGROUND:During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for main...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2015-04, Vol.122 (4), p.736-745
Main Authors: Ngan Kee, Warwick D, Lee, Shara W Y, Ng, Floria F, Tan, Perpetua E, Khaw, Kim S
Format: Article
Language:English
Subjects:
Adult
Anesthesia, Spinal - trends
Blood Pressure - drug effects
Blood Pressure - physiology
Blood Pressure Determination - methods
Cesarean Section - trends
Double-Blind Method
Female
Humans
Monitoring, Intraoperative - methods
Norepinephrine - administration & dosage
Phenylephrine - administration & dosage
Pregnancy
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Summary:BACKGROUND:During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. METHODS:In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. RESULTS:Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. CONCLUSIONS:When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.
ISSN:0003-3022
1528-1175
DOI:10.1097/ALN.0000000000000601