Management of Hypotension Post Subarachnoid Block in C Section Patients: What‘s the Difference between Ephedrine Vs Phenylephrine?

Abstract

Aims: The present review is aimed at revisiting the caesarean delivery under spinal anesthesia, comparing the application of two different vasopressors namely ephedrine and phenylephrine. For understanding beneficiary along with unwanted hypotensive effect between the two drugs. Discussion: Elective cesarean sections are so commonly performed under spinal anesthesia. Unfortunately, this procedure often leads to hypotension, which may adversely jeopardize maternal and fetal outcomes. Immediate post spinal anesthesia hypotension is basically elucidated as reduction of normal blood pressure, estimated 80–90% below its baseline value. Various strategies have been implemented to reduce the incidence of spinal anesthesia-induced hypotension, including the immediate administration of vasopressors such as phenylephrine and or ephedrine, aimed for preventing and treating hypotension. Clinically, both phenylephrine and ephedrine were proven effective in protecting normal maternal hemodynamic balance by counteract the unwanted effect of hypotension both to the maternal and the newborn. Newborns benefited more from the application of phenylephrine in elective cesarean delivery, compared to those who receive ephedrine, but unfortunately not in unscheduled emergency cesarean delivery or in vulnerable parturient with pre-eclampsia. More in depth clinical study should be conducted to obtain more conclusive results, especially regarding the most effective prevention and predictive method, its active surveillance during critical anesthesiology procedure throughout cesarean sectio and recovery from hypotension chronologically.