Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia
Objective: The frequency of maternal hypotension after spinal anesthesia in Caesarean section (CS) may be as high as 90%. The aim of this study was to investigate the effect of the use of the combination of ephedrine and norepinephrine on maternal hemodynamics, neonatal APGAR and acidosis in CS deli...
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Atatürk University
2025-04-01
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| Series: | Trends in Surgical Sciences |
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| Online Access: | https://dergipark.org.tr/tr/download/article-file/4751917 |
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| author | Nurçin Gülhaş Nurettin Kurt Nureddin Yuzkat Celaleddin Soyalp |
| author_facet | Nurçin Gülhaş Nurettin Kurt Nureddin Yuzkat Celaleddin Soyalp |
| author_sort | Nurçin Gülhaş |
| collection | DOAJ |
| description | Objective: The frequency of maternal hypotension after spinal anesthesia in Caesarean section (CS) may be as high as 90%. The aim of this study was to investigate the effect of the use of the combination of ephedrine and norepinephrine on maternal hemodynamics, neonatal APGAR and acidosis in CS delivery under spinal anesthesia.Methods: This prospective, randomized, double-blind study included pregnant patients aged 18 - 45 years, evaluated as ASA class I-II for surgery, who underwent elective CS under spinal anesthesia. The clinical and laboratory findings, umbilical blood gases, maternal blood pressure and heart rate were also analyzed. The patients were randomly separated into 3 groups: Ephedrine (E), Ephedrine+Norepinephrine (EN), and Norepinephrine (N).Results: Umbilical cord venous blood pH and HCO3 was lower in Group EN than the other groups. APGAR score was lower in Group E. Heart rate in Groups EN and N decreased up to the middle of surgery, then was slightly elevated until the end of surgery. Heart rate persistently decreased in Group E from the beginning to the end of the surgery. SBP decreased significantly at the end of the surgery compared to basal levels in Group EN and N, and did not decrease significantly in Group E. Conclusion: These findings suggest that the addition of norepinephrine to ephedrine might increase the risk of fetal acidosis and affect the APGAR score. The longer duration of action and the higher number of bolus of ephedrine might be associated with a lesser decrease in maternal blood pressure after the middle of the surgery. |
| format | Article |
| id | doaj-art-50d50ad3ba0c4c5ebaffd34d646f0671 |
| institution | DOAJ |
| issn | 3062-3308 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Atatürk University |
| record_format | Article |
| series | Trends in Surgical Sciences |
| spelling | doaj-art-50d50ad3ba0c4c5ebaffd34d646f06712025-08-20T02:40:30ZengAtatürk UniversityTrends in Surgical Sciences3062-33082025-04-014111010.61745/tss.167143155Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal AnesthesiaNurçin Gülhaş0https://orcid.org/0000-0002-2539-9017Nurettin Kurt1https://orcid.org/0000-0001-7713-5120Nureddin Yuzkat2https://orcid.org/0000-0002-8218-1217Celaleddin Soyalp3https://orcid.org/0000-0002-2687-5329Department of Anesthesiology and Reanimation, İnönü University, Faculty of Medicine, Malatya, TürkiyeDepartment of Anesthesiology and Reanimation, Van Yüzüncü Yıl Universty, Faculty f Medicine, Van, TürkiyeDepartment of Anesthesiology and Reanimation, Van Yüzüncü Yıl Universty, Faculty f Medicine, Van, TürkiyeDepartment of Anesthesiology and Reanimation, Van Yüzüncü Yıl Universty, Faculty f Medicine, Van, TürkiyeObjective: The frequency of maternal hypotension after spinal anesthesia in Caesarean section (CS) may be as high as 90%. The aim of this study was to investigate the effect of the use of the combination of ephedrine and norepinephrine on maternal hemodynamics, neonatal APGAR and acidosis in CS delivery under spinal anesthesia.Methods: This prospective, randomized, double-blind study included pregnant patients aged 18 - 45 years, evaluated as ASA class I-II for surgery, who underwent elective CS under spinal anesthesia. The clinical and laboratory findings, umbilical blood gases, maternal blood pressure and heart rate were also analyzed. The patients were randomly separated into 3 groups: Ephedrine (E), Ephedrine+Norepinephrine (EN), and Norepinephrine (N).Results: Umbilical cord venous blood pH and HCO3 was lower in Group EN than the other groups. APGAR score was lower in Group E. Heart rate in Groups EN and N decreased up to the middle of surgery, then was slightly elevated until the end of surgery. Heart rate persistently decreased in Group E from the beginning to the end of the surgery. SBP decreased significantly at the end of the surgery compared to basal levels in Group EN and N, and did not decrease significantly in Group E. Conclusion: These findings suggest that the addition of norepinephrine to ephedrine might increase the risk of fetal acidosis and affect the APGAR score. The longer duration of action and the higher number of bolus of ephedrine might be associated with a lesser decrease in maternal blood pressure after the middle of the surgery.https://dergipark.org.tr/tr/download/article-file/4751917post-spinal hypotensionvasopressornorepinephrineephedrinecaesarean section |
| spellingShingle | Nurçin Gülhaş Nurettin Kurt Nureddin Yuzkat Celaleddin Soyalp Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia Trends in Surgical Sciences post-spinal hypotension vasopressor norepinephrine ephedrine caesarean section |
| title | Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia |
| title_full | Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia |
| title_fullStr | Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia |
| title_full_unstemmed | Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia |
| title_short | Effects of Norepinephrine-Ephedrine Combination on Maternal Hemodynamics in Cesarean Sections Performed Under Spinal Anesthesia |
| title_sort | effects of norepinephrine ephedrine combination on maternal hemodynamics in cesarean sections performed under spinal anesthesia |
| topic | post-spinal hypotension vasopressor norepinephrine ephedrine caesarean section |
| url | https://dergipark.org.tr/tr/download/article-file/4751917 |
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