Revisiones_bibliográficas TyO_Web: Fenilefrina y efedrina en embarazo de alto riesgo / Phenylephrine and Ephedrine in High-Risk Pregnancies

lunes, 27 de febrero de 2017

Fenilefrina y efedrina en embarazo de alto riesgo / Phenylephrine and Ephedrine in High-Risk Pregnancies

Febrero 26, 2017. No. 2612

Comparación de fenilefrina y efedrina en el tratamiento de hipotensión inducida por raquia en embrazo de alto riesgo. Revisión narrativa

Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review.

Dusitkasem S1, Herndon BH2, Somjit M3, Stahl DL2, Bitticker E4, Coffman JC2.

Front Med (Lausanne). 2017 Jan 20;4:2. doi: 10.3389/fmed.2017.00002. eCollection 2017.

Abstract

PURPOSE: To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. SOURCE: An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." PRINCIPLE FINDINGS: Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. CONCLUSION: From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.

KEYWORDS: ephedrine; fetal compromise; hypotension; phenylephrine; preeclampsia; uteroplacental insufficiency

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