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A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.

Publication ,  Journal Article
George, RB; McKeen, DM; Dominguez, JE; Allen, TK; Doyle, PA; Habib, AS
Published in: Can J Anaesth
March 2018

PURPOSE: Hypotension is common after spinal anesthesia for Cesarean delivery. It is associated with nausea, vomiting, and fetal acidosis. Previous research on phenylephrine excluded obese subjects. We compared the incidence of intraoperative nausea and vomiting (IONV) in obese patients who received a prophylactic phenylephrine infusion vs those who received bolus dosing for the treatment of spinal-induced hypotension. METHODS: In this multicentre, double-blinded randomized controlled trial, 160 obese women undergoing elective Cesarean delivery under spinal anesthesia were randomized to receive a prophylactic phenylephrine infusion initiated at 50 μg·min-1 (and titrated according to a predefined algorithm) or 100 μg phenylephrine boluses to treat hypotension. Maternal systolic blood pressure was maintained within 20% of baseline. The primary study outcome was the incidence of IONV. RESULTS: Intraoperative nausea and vomiting were significantly reduced in the infusion group compared to the bolus group (46% vs 75%, respectively; relative risk [RR], 0.61; 95% confidence interval [CI], 0.47 to 0.80; P < 0.001). This was associated with significantly reduced need for intraoperative rescue antiemetics (26% vs 42%, respectively; RR, 0.62; 95% CI, 0.40 to 0.97; P = 0.04), but no difference in the incidence of vomiting. Postoperative vomiting at two hours was reduced in the infusion group (11% vs 25%; RR, 0.44; 95% CI, 0.21 to 0.90; P = 0.02);however, there were no differences in the incidence or severity of postoperative nausea, need for rescue antiemetics at two hours and 24 hr, or the incidence of postoperative vomiting at 24 hr. CONCLUSION: In obese women undergoing Cesarean delivery with spinal anesthesia, prophylactic phenylephrine infusion was associated with less intraoperative nausea, less need for rescue antiemetics, and reduced early postoperative vomiting. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01481740). Registered 22 July 2011.

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Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

March 2018

Volume

65

Issue

3

Start / End Page

254 / 262

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Phenylephrine
  • Obesity
  • Injections, Intravenous
  • Infusions, Intravenous
  • Incidence
  • Hypotension
  • Humans
 

Citation

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George, R. B., McKeen, D. M., Dominguez, J. E., Allen, T. K., Doyle, P. A., & Habib, A. S. (2018). A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. Can J Anaesth, 65(3), 254–262. https://doi.org/10.1007/s12630-017-1034-6
George, Ronald B., Dolores M. McKeen, Jennifer E. Dominguez, Terrence K. Allen, Patricia A. Doyle, and Ashraf S. Habib. “A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.Can J Anaesth 65, no. 3 (March 2018): 254–62. https://doi.org/10.1007/s12630-017-1034-6.
George RB, McKeen DM, Dominguez JE, Allen TK, Doyle PA, Habib AS. A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. Can J Anaesth. 2018 Mar;65(3):254–62.
George, Ronald B., et al. “A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women.Can J Anaesth, vol. 65, no. 3, Mar. 2018, pp. 254–62. Pubmed, doi:10.1007/s12630-017-1034-6.
George RB, McKeen DM, Dominguez JE, Allen TK, Doyle PA, Habib AS. A randomized trial of phenylephrine infusion versus bolus dosing for nausea and vomiting during Cesarean delivery in obese women. Can J Anaesth. 2018 Mar;65(3):254–262.
Journal cover image

Published In

Can J Anaesth

DOI

EISSN

1496-8975

Publication Date

March 2018

Volume

65

Issue

3

Start / End Page

254 / 262

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Phenylephrine
  • Obesity
  • Injections, Intravenous
  • Infusions, Intravenous
  • Incidence
  • Hypotension
  • Humans