Introduction: Spinal anesthesia is a commonly used anesthetic technique for cesarean section. The hypotension is the serious and common complication for it. Prevention of this complication is an important challenge for anesthesiologists. Objective: The aim of this study is to compare the effect of prophylactic bolus injection of PHENYLEPHRINE.and EPHEDRINE in the prevention of hypotension during spinal anesthesia in elective cesarean section. Materials and Methods: In this double-blind randomized clinical trial, in order to prevent hypotension in cesarean section, 80 pregnant women who were candidates for elective cesarean section were randomly assigned to two groups (PHENYLEPHRINE.or EPHEDRINE). Immediately after spinal anesthesia, the first group received 10 mg EPHEDRINE and in the second group, 100 micrograms of PHENYLEPHRINE.was injected bolus intravenously. Both groups were evaluated for nausea and vomiting, systolic, diastolic, mean arterial pressure, heart rate and SPO2 at specific intervals. The neonatal Apgar score was evaluated at first and fifth minutes after birth. The collected data were analyzed by SPSS software version 16 at 95% confidence interval. Results: Although nausea and vomiting, systolic, diastolic and mean arterial pressure were higher in the EPHEDRINE group than the PHENYLEPHRINE.group, there were no significant differences between the two groups. There was also no significant difference between two groups in incidence of mean heart rate and SPO2 during surgery. There was no significant difference in neonatal Apgar score at first and fifth minutes between them. Conclusion: In cesarean section, intravenous bolus injection of PHENYLEPHRINE.without affecting the incidence of maternal nausea and vomiting and neonatal Apgar score, such as EPHEDRINE is effective in the prevention of hypotension following spinal anesthesia.

Background: Neuraxial anesthesia is an acceptable technique in pregnant females for cesarean section and up to 71% of pregnantpatients have hemodynamic complications, especially hypotension. Objectives: This study aimed at comparing the effectiveness of PHENYLEPHRINE.versus EPHEDRINE in treatment of maternal hypotensiondue to spinal anesthesia for elective cesarean section to determine drug efficacy and fewer side effects. Methods: In this randomized double blind clinical study, 124 pregnant females, who were admitted to Ali ibn Abi Talib hospital inZahedan, Iran, between 2015and2016, for elective cesarean section, were selected by the Block randomization sampling method. Thesamples were divided to 4 groups: Group I received 5mgEPHEDRINE bolus, Group II was administered 10mgbolus EPHEDRINE, GroupIII were delivered PHENYLEPHRINE.bolus of 50 mcg, and Group IV 100 mcg PHENYLEPHRINE.bolus in case of hypotension. Neonataloutcome and maternal side effects, hemodynamics changes, and Apgar score were controlled and recorded. Results: In terms of hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and pulse rate), there was a significantdifference between the groups (P < 0. 0001). The umbilical arterial pH value and base excess between EPHEDRINE and PHENYLEPHRINE.roups were significantly different (P < 0. 0001), and fetal acidosis in the EPHEDRINE group was found. Nausea and vomitingwas significant between the 2 groups (P = 0. 03), while the incidence of nausea and vomiting in the EPHEDRINE group was higher thanthe other groups. There was no difference between the 2 groups in the first-and fifth-minute Apgar (P = 1). Conclusions: Control of blood pressure during spinal 50-mcg PHENYLEPHRINE.is recommended.

BACKGROUND AND OBJECTIVE: Hypotension after spinal anesthesia is a common and potentially dangerous complication, prompt and accurate prevention and treatment of which are of paramount importance. In the recent studies there have been conflicting results regarding the efficacy of PHENYLEPHRINE.and EPHEDRINE in the prevention and treatment of hypotension after spinal anesthesia. Thus, in this study, we purport to compare the effects of PHENYLEPHRINE.and EPHEDRINE in the treatment of hypotension after spinal anesthesia for lower limb orthopedic surgery. METHODS: This double-blind clinical trial was conducted on 110 ASAI-II patients aged 40-65 years, who were candidates for orthopedic surgery of lower limbs under spinal anesthesia with 3 mL of bupivacaine 0.5%. The subjects were randomly divided into two groups of 55. After observing 20% fall in blood pressure or blood pressure less than 90/60 mm/Hg, the first group received 50 mg of PHENYLEPHRINE.and the second group was administered 5 mg of intravenous EPHEDRINE. Information concerning the hemodynamic status of the patients was collected and compared.. FINDINGS: PHENYLEPHRINE.was more effective in the treatment of systolic and diastolic hypotension following spinal anesthesia compared to EPHEDRINE (systolic blood pressure: 119±10.6 vs.112.35±10.34 nc and diastolic blood pressure: 73.42 ± 6.67 vs.70.05 ± 6.15 nc). However, it should be noted that except for 2 and 4 minutes after administration of vasopressor, there was no statistically significant difference between the two groups. In both groups, heart rate elevated simultaneously with decrease in blood pressure.CONCLUSION: The results revealed that PHENYLEPHRINE.was more effective in the treatment of hypotension following spinal anesthesia compared to EPHEDRINE in lower limb orthopedic surgery.

The aim of this study Was to compare the antihypotensive effects of sublingual PHENYLEPHRINE.and parenteral after spinal anesthesia. 120 patient who needed spinal anesthesia were selected.In 60 patients. 2mg of sublingul PHENYLEPHRINE.and in others, 2mg parenteral EPHEDRINE was used before anesthesia. Systolic and diastolic blood pressure, MAP, heart rate and O2 Saturation were compared. The mean systolic blood presure in the PHENYLEPHRINE.group (group1) was 120.3± 6.5 mmHg and 119.2±6.7mm/Hg in the ephedrime group (P=0.97) . The mean diastolic blood pressure in group I was 74± 14.39mm/Hg and 69.1± 5.9mm/Hg in group II(P=0.21) . MAP in group I was 104.5 ±6.4mm/Hg and 102.4 ± 5.6 mm/Hg in group II ( P=0.82) . The mean heart rate in the two groups were 74.07± 4.9 and 79.3±4.7 perminute respectively (P=0.9) . Our findings suggest that sublingual PHENYLEPHRINE.can be used to prevent hypotension due to spinal anesthesia.

Introduction: Hypertension in obese patients is more affected by spinal anesthesia than normal people. Due to the lack of study and recommendation of articles about comparison of EPHEDRINE and PHENYLEPHRINE.in obese patients during cesarean section, this study was performed with aim to compare the effect of hypotension treatment due to spinal anesthesia with EPHEDRINE and PHENYLEPHRINE.on the status of arterial blood gas and Apgar score during cesarean delivery in obese mothers. Methods: This randomized clinical trial was performed in 2016 on 100 pregnant women with BMI≥ 30kg/m2 (according to the formula) who were candidates for elective cesarean section in Tabriz Alzahra Hospital. Demographic characteristics and maternal and fetal status as well as analysis of arterial blood gases of umbilical artery were included in the researcher-made checklist. Data were analyzed by SPSS software (version 20) and t-test, Chi-square and Mann-Whitney U test. P< 0. 05 was considered statistically significant. Results: There was statistically significant difference between two groups in terms of HCO3-(P=0. 048), BE (P=0. 035), heart rate (P=0. 002), systolic (P=0. 003) and diastolic (P=0. 004) blood pressure during anesthesia and surgery; PHENYLEPHRINE.group had more stability. No significant difference was found between two groups in terms of other variables (blood pressure and arterial oxygen saturation) (P>0. 06) and neonatal Apgar score (first and fifth minutes) (P>0. 05). Conclusion: PHENYLEPHRINE.leads to better and more effective treatment of hypertension than EPHEDRINE in pregnant women with BMI≥ 30kg /m2 with spinal anesthesia; also neonatal complications such as metabolic acidosis have been less observed in obese patients treated with PHENYLEPHRINE.

Introduction: One of the methods used in cesarean section is spinal anesthesia that have major role in cesarean section. One complication of spinal anesthesia is hypotension. This study was performed with aim to compare the effects of PHENYLEPHRINE.and EPHEDRINE in the treatment of hypotension due to spinal anesthesia in pregnant women who are candidates for cesarean section. Methods: This randomized, double-blind, clinical trial study was performed on 74 healthy pregnant women candidate for ceasarian section under spinal anesthesia who referred to Firoozgar hospital in Tehran in 2017-2018. Patients were randomly assigned to two groups: PHENYLEPHRINE.or EPHEDRINE. Patients received PHENYLEPHRINE.or EPHEDRINE immediately after hypotension due to spinal anesthesia. During the surgery, hemodynamic variables including systolic, diastolic blood pressure and heart rate were measured every 5 minutes. After the removal of the baby, the umbilical cord blood gases were analyzed; first and fifth minutes Apgar score were recorded. Data were analyzed by SPSS software (version 21) and Repeated measures ANOVA. P<0. 05 was considered statistically significant. Results: There was no significant difference between systolic blood pressure in two groups during surgery (P>0. 05). The diastolic blood pressure during surgery at 5, 10, 15, 20, 25 and 30 minutes after the removal of the baby was significantly less in the PHENYLEPHRINE.group than EPHEDRINE group (P<0. 05). Heart rate of patients during surgery except minutes before spinal anesthesia, 6 min after spinal anesthesia, 40 and 45 after the removal of the newborn was significantly less in the PHENYLEPHRINE.group than EPHEDRINE group (P<0. 05). First minute Apgar score was significantly higher in PHENYLEPHRINE.group than the EPHEDRINE group (P<0. 05). Fifth minute Apgar score was not significantly different between the two groups (P >0. 05). There was no significant difference in the PH of newborns in two groups (P>0. 05). Conclusion: Both ephedrin and PHENYLEPHRINE.can be used in treatment of hypotension due to spinal anesthesia in pregnant women candidate for caesarean section, without any significant differences in control of systemic blood pressure and minimum effect on Apgar score.

Several techniques have been proposed to prevent hypotension in obstetric patients. EPHEDRINE and PHENYLEPHRINE.are individually used to prevent maternal hypotension; however, each has its own drawbacks. Some researchers have reported that the infusion of combined EPHEDRINE and PHENYLEPHRINE.immediately after spinal anesthesia for cesarean delivery reduces the incidence of maternal hypotension. Other studies have indicated that the combination is not superior to the infusion of an individual agent. The present study aimed to evaluate the effect of prophylactic infusion of EPHEDRINE and PHENYLEPHRINE.before the induction of spinal anesthesia for cesarean section on maternal hemodynamic. In a randomized, double-blinded clinical trial study, 90 pregnant women that underwent elective cesarean delivery under spinal anesthesia were recruited. Before the spinal anesthesia, the infusion of combined EPHEDRINE and PHENYLEPHRINE.during 15 minutes (study group) or serum NaCl 0. 9% (placebo group) was performed. Hemodynamic parameters and fetal blood gas were recorded. The data were analyzed using the SPSS software, version 16. 0. The results showed that hypotension and bradycardia after spinal anesthesia were less in the study group. The need for vasopressors and inotropes to treat hypotension, nausea, and vomiting were higher in the placebo group. First-and fifth-minute Apgar scores were higher in the study group. The prophylactic infusion of low-dose EPHEDRINE and PHENYLEPHRINE.before spinal anesthesia for cesarean delivery can be used to decrease the frequency and severity of maternal hypotension and its side effects to the mother and neonate.