Publication: Comparison of prophylaxis phenylephrine infusion and rescue bolus administration for maintaining blood pressure during spinal anaesthesia for caesarean delivery in obese women
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Date
2022
Authors
Cui, Wong Pit
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Abstract
Background: Obesity and Caesarean section (CS) have been identified as independent risk factors for maternal morbidity and mortality. Regional anaesthesia should ideally be used for all Caesarean delivery unless contraindicated. However, maternal hypotension, a recognized complication of post-spinal anaesthesia, found more severe among obese mothers. Phenylephrine (PE) is a preferred choice of vasopressor in this setting as it results in better neonatal outcomes. This study investigates the effect of prophylactic PE infusion on the haemodynamics of obese parturients undergoing elective CS under spinal anesthesia. (SA) Methods: This was stratified balanced randomization, double blinded, parallel group study conducted in Hospital Universiti Sains Malaysia. A total of 74 parturients scheduled for elective CS under SA were randomized into two arms, Group A (n=37) received prophylactic PE infusion starting at 50 μg/min and adjusted according to the given algorithm or Group B (n=37) who received 100 μg phenylephrine bolus to treat post-spinal hypotension. The primary outcome measured included systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean artery pressure (MAP). The secondary outcomes were the total requirement of PE and neonatal Apgar scores. Results: Six patients were excluded from the analysis due to missing data. The result showed that SBP, DBP, and MAP were statistically significantly higher in the prophylactic infusion group compared with the therapeutic bolus group (p<0.05). The mean difference of SBP, DBP, and MAP between the two groups were significant. The mean requirement of PE was higher in the infusion group compared with the bolus group. Both groups have no difference in terms of neonatal Apgar score. Conclusion: Prophylactic PE infusion provides more excellent haemodynamic stability control than therapeutic PE boluses among obese parturients with BMI between 30 -40 kg/m2 undergoing CS under SA.
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Keywords
phenylephrine , Caesarean section