Prevention of Hemodynamic Instability: A Comparative Double Blind Study With Phenylephrine On Patients With Un-booked Cesarean Section

Sagar Khurana, Ziauddin Kashmiri, Shakil Malik, Muhammad Imran Riasat, Hanya Javaid, Syed Farjad Sultan

Abstract

Objective

To compare the use of prophylactic continuous infusion and bolus dose of phenylephrine in preventing hypotension in un-booked patients who underwent  emergency cesarean section.

Study design

Comparative study.

Place & Duration of study

Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Dr. Ruth K M Pfau Civil Hospital Karachi, from February 2019 to August 2019.

Methodology

A total of 212 un-booked patients undergoing cesarean section requiring spinal anesthesia were included. Patients were randomly allocated into two groups. Group 1 received continuous intravenous phenylephrine infusion at at the rate of 15ug/kg/min while group 2 received single prophylactic bolus intravenous dose of 50ug phenylephrine. Blood pressure and heart rate were recorded at baseline (before spinal anesthesia), then at 1min, 3min,7min, 10min, 20min, 30min, and 40minutes after subarachnoid injection of hyperbaric bupivacaine. Effectiveness was labelled when there was no hypotensive episode; a decrease in of systolic blood pressure (SBP) of more than 20% from the baseline.

Results

A total of 204 patients completed the study and were analyzed for effectiveness which was significantly high in group 1 when compared to group 2 (p =0.018).

Conclusion

Among un-booked gravid patients requiring cesarean section, a prophylactic infusion of phenylephrine was more effective in preventing maternal hypotension than a prophylactic bolus dose of phenylephrine.

Key words

Phenylephrine, Hemodynamic instability, Spinal anesthesia, Cesarean section.