Efficacy of etilefrine and norepinephrine in preventing maternal hypotension during cesarean section under spinal anesthesia: an observational study

Eficacia de la etilefrina y la norepinefrina en la prevención de la hipotensión materna durante la cesárea bajo anestesia espinal: estudio observacional

Abstract

Objective: To compare the efficacy and safety of norepinephrine and etilefrine for the prevention of maternal hypotension during cesarean sections under spinal anesthesia at the National Maternal Perinatal Institute in Lima, Peru. Materials and Methods: A prospective study was conducted with 300 pregnant women, with the respective inclusion and exclusion criteria; of which they were divided into three groups: norepinephrine in continuous infusion (NEI), bolus (NEB), and etilefrine in bolus (EB) until delivery. Maternal hemodynamic variables were evaluated: systolic blood pressure, diastolic pressure, mean arterial pressure, heart rate, use of vasopressor, number of rescue boluses, APGAR score of newborns, use of oxygen in immediate care, criteria for admission to the Neonatal Intensive Care Unit; and other demographic variables such as age group, nutritional status, parity.Results: Norepinephrine infusion significantly reduced episodes of hypotension compared to etilefrine (p < 0.001) and norepinephrine bolus (p < 0.001), with no differences in APGAR scores (p = 0.72). Norepinephrine infusion proved superior, reducing hypotension episodes by 39% compared to etilefrine, and by 47% compared to norepinephrine bolus. In addition, it was observed that in the norepinephrine infusion group, maternal systolic blood pressure remained constant, unlike in the other norepinephrine bolus and ethylephrine bolus groups. Regarding heart rate, it was observed that after administration of the EB group bolus, heart rate increased significantly, even above 80 beats per minute, and remained so for twenty minutes thereafter; unlike the average of the other groups, which ranges from 72 to 77 beats per minute. Conclusions: Norepinephrine administered via continuous infusion was more effective than etilefrine in preventing maternal hypotension, without compromising neonatal safety. n our study, it was demonstrated that norepinephrine infusion better maintains maternal hemodynamic parameters such as systolic pressure, mean pressure and heart rate; without repercussions on the APGAR score, nor neonatal compromise such as stay in the Neonatal Care Unit or the use of oxygen in immediate care. The use of norepinephrine infusion as prophylaxis of hypotension after spinal anesthesia in cesarean section was safe and effective in the population studied and had a more stable hemodynamic pattern compared to the drugs studied.

Key words Anesthesia, Spinal, c-section, local anesthesics, hypotension (Source: MESH, NLM).