In:
Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. 3 ( 2017-09), p. 904-906
Abstract:
Phenylephrine infusions are considered as standard management for obstetric spinal hypotension, but there remains reluctance to implement them in resource-limited contexts. This prospective, alternating intervention study of patients undergoing elective or urgent cesarean delivery under spinal anesthesia compared a vasopressor bolus strategy to fixed-rate, low-dose prophylactic phenylephrine infusion with supplemental boluses. The primary outcome was the incidence of severe hypotension (mean arterial pressure 〈 70% baseline or systolic blood pressure 〈 80 mm Hg). Fewer patients receiving prophylactic phenylephrine infusions had severe hypotension (47.4% [n = 120/253] vs 62.1% [n = 157/253] , P = .001, estimated relative risk 0.84, 95% confidence interval, 0.69–1.02), with no significant difference in the rate of hypertension (15% [n = 39/253] vs 11% [n = 27/253] , P = .11, estimated relative risk 1.39, confidence interval 0.87–2.20). Guidelines for resource-constrained settings should consider a fixed, low-dose phenylephrine infusion in combination with rescue vasopressor bolus therapy.
Type of Medium:
Online Resource
ISSN:
0003-2999
DOI:
10.1213/ANE.0000000000001905
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2017
detail.hit.zdb_id:
2018275-2
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