Randomized Double-Blinded Comparison of Intermittent Boluses Phenylephrine and Norepinephrine for the Treatment of Postspinal Hypotension in Patients with Severe Pre-Eclampsia During Cesarean Section

Figures & data

Table 1 The Demographic Data, Baseline Characteristics, Intraoperative Details and Maternal Side Effect

	Phenylephrine (n=39)	Norepinephrine (n=39)	P value
Age (years)	31.7±4.2	32.5±4.5	0.407
Height (cm)	159.9±5.7	159.4±5.6	0.661
Weight (kg)	75.4±10.0	75.3±11.6	0.974
Gestational age (weeks)	37(34.0–38.6)	37.1(34.0–38.0)	0.920
Height of block (thoracic dermatome)	5(4–6)	5(4–6)	0.852
Baseline
MAP (mmHg)	117.4±11.4	118.3±13.4	0.791
HR (bpm)	85.2±9.6	83.4±10.9	0.443
Time Intervals
Spinal anesthesia to delivery interval (min)	14(12–17)	14(12–17)	0.794
Skin incision to delivery interval (min)	6(4–9)	6(4–9)	0.864
Total number of boluses given	2(1–3)	2(1–3)	0.942
Intravenous fluid volume given before delivery (mL)	456.4±110.9	460.3±131.9	0.890
Bradycardia	8(20.5%)	2(5.1%)	0.042
Hypertension	0	0	NS
Nausea	2	2	1.000
Vomiting	0	0	NS
Dizziness	0	0	NS

Notes: Data are represented as mean±SD(standard deviation), or median (inter-quartile range) or number (%). NS, not significant.

Figure 1 Flow diagram of study.

Table 2 Neonatal Outcomes

	Phenylephrine (n=39)	Norepinephrine (n=39)	P value
Neonatal weight (g)	2640(1550–3150)	2840(2010–3110)	0.337
Apgar score (0–10)
at 1min	10(9–10)	10(9–10)	0.742
at 5min	10(10–10)	10(10–10)	0.085
at 1min<7	1	1	1.000
at 5min<9	1	1	1.000
Umbilical arterial blood gases
pH	7.303±0.38	7.303±0.44	0.978
pH<7.2	0	0	NS
PO2 (mmHg)	10.62±4.17	10.82±4.98	0.844
PCO2 (mmHg)	53(50–56)	53(48–58)	0.944
HCO3 (mEq L^−1)	25.61±2.84	25.64±2.41	0.952
Base excess	−1.32±2.43	−1.33±2.51	0.988
Lactate (mmol L^−1)	1.9(1.7–2.5)	1.9(1.5–2.5)	0.568
Umbilical venous blood gases
pH	7.35±0.03	7.34±0.05	0.376
pH< 7.2	0	0	NS
PO2 (mmHg)	22.26±8.0	21.28±7.1	0.572
PCO2 (mmHg)	42.13±5.3	44.05±6.4	0.152
HCO3 (mEq L^−1)	22.51±2.48	23.48±2.15	0.069
Base excess	−2.2[−3.4-(−1.6)]	−1.9[−3.5-(−0.6)]	0.924
Lactate (mmol L^−1)	1.8(1.6–2.2)	1.8(1.4–2.1)	0.165

Notes: Data are represented as mean±SD, or median (inter-quartile range) or number (%). NS, not significant.

Table 3 Baseline Hemodynamics Obtained by the TL-400. Hemodynamic Data Were Not Available for 25 Patients

	Phenylephrine (n=27)	Norepinephrine (n=26)	P value
Baseline
CO (l min^−1)	5.79±0.59	5.97±0.78	0.244
SV (mL)	69±9.6	73±12.4	0.171
SVR (dyn s cm^−5)	1393±185	1346±123	0.190

Note: Data are represented as mean±SD.

Figure 2 Changes in cardiac output (CO) for all patients plotted against time. Values on the x-axis corresponded to the number of each consecutive CO measurement made with the TL-400 monitor set to record at 1-min.

Figure 3 Bars show the area under the curve (AUC) for the two groups standardized for each patient by dividing by the number of data points recorded. Comparison of the calculated values for standardized AUC showed that CO was greater over time in the norepinephrine group versus the phenylephrine group (P = 0.009).

Figure 4 Serial changes in mean arterial pressure (MAP) for the first 12 minutes after subarachnoid block, data are presented as mean and standard deviation(SD). The value at time 0 corresponds to the baseline value.

Figure 5 Serial changes in heart rate (HR) for the first 12 minutes after subarachnoid block, data are presented as mean and SD. The value at time 0 corresponds to the baseline value.

Figure 6 Serial changes in CO for the first 12 minutes after subarachnoid block, data are presented as mean and SD. The value at time 0 corresponds to the baseline value.