Effect on Neonatal Acid–Base Status of Phenylephrine and Norepinephrine Boluses for Management of Spinal Anesthesia-Induced Hypotension in Patients with Preeclampsia Undergoing Cesarean Delivery: A Randomized, Double-Blinded Trial

Abstract

Purpose: Phenylephrine (PE) is the vasopressor of choice for spinal induced hypotension. In recent studies, norepinephrine (NE) has been used to manage hypotension following spinal anesthesia. However, its effect on neonatal acid–base status in preeclamptic mothers has not been well established. The aim of this study is to compare the neonatal acid–base outcomes of bolus doses of PE versus NE for the prevention of spinal anesthesia-induced hypotension in nonlaboring preeclamptic patients undergoing cesarean section. Methods: A randomized, double-blind study was conducted on 50 nonlaboring patients diagnosed with preeclampsia posted for cesarean section under spinal anesthesia. Patients were randomized to receive bolus doses of either PE or NE following hypotension. Neonatal umbilical artery blood gas analysis and maternal hemodynamics were compared. All the statistical tests were two sided and performed at a significance level of 0.05. Results: The study did not reveal any difference in the primary outcome of umbilical artery pH when using PE or NE in patients with preeclampsia (P 0.90). The secondary outcomes were also comparable. Conclusion: Our study shows that PE and NE are comparable in terms of fetal umbilical artery blood pH in nonlaboring preeclamptic patients undergoing cesarean section under spinal anesthesia.

Keywords

• cesarean section
• hypotension
• neonate
• norepinephrine
• phenylephrine
• preeclampsia
• spinal anesthesia