Faculty Advisor(s)

Maribeth Massie

Document Type

Capstone

Publication Date

5-2017

Rights

© 2017 Safira Iddriss

Abstract

Hypotension is a well-recognized phenomenon associated with any spinal anesthesia. It is most particularly evident in the parturients as a higher block is required for cesarean section (C-section) (Nagelhout, 2014). These populations are also more prone to the effect of sympathectomy because of decreased sensitivity to endogenous vasoconstrictors in addition to increased synthesis of endothelium vasodilators (Miller, 2009). Sympathectomy results in hypotension and other adverse effects such as nausea and vomiting. Many studies over the decades have examined the best management option for the hypotension. This review seeks to determine the best management regimen for the use of the vasopressor phenylephrine. Eleven studies are used to examine the use of prophylactic intravenous (IV) phenylephrine infusion versus IV bolus regimen to manage the sympathectomy-induced hypotension associated with spinal anesthesia in parturients undergoing C-section. Nine out of the eleven had better hemodynamic outcomes with the use of infusion over bolus regimes. When the use of a weight-based prophylactic IV phenylephrine infusion was compared to a non-weight based infusion, the intervention group was hemodynamically more stable compared to the control group whose weights were omitted in the dose. While there were incidences of reactive hypertension with the control group, there was no statistically significant adverse effect on the parturients and the fetus. These findings suggest that it is best for anesthesia providers to use a weight-based prophylactic IV phenylephrine infusion for the management of spinal-induced hypotension.

Comments

Master's capstone

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