Abstract

Subarachnoid block for patients undergoing cesarean delivery is common practice amongst anesthesia providers caring for the parturient population. Advantages of this type of anesthetic for cesarean delivery provide a number of benefits which this study will not seek to extrapolate upon. Numerous studies have looked at the variations between medications used in spinal anesthesia (isobaric, hyperbaric, local anesthetics, narcotics, etc.) and how they impact adverse effects but regardless of the drug used, they all cause some degree of sympathectomy. Because of this known side effect for this particular anesthetic, severe and sustained hypotension may result due to the sympathectomy created by the block. The resultant sympathectomy may cause a significant decrease in systemic vascular resistance, which may lead to adverse side effects including "nausea, dizziness, and decreased uteroplacental perfusion".

To counteract the sympathectomy and decrease maternal and neonatal deleterious effects, the potent alpha-adrenergic receptor agonist phenylephrine (PE) is commonly used to manage intraoperative hypotension in the setting of subarachnoid block. PE itself is associated with negative effects including reflex bradycardia, decreased cardiac output, and lactic acidosis from decreased peripheral flow. It is then hypothesized that norepinephrine (NE) has theoretical pharmacologic advantages over PE due to NE having weak beta-adrenergic agonizing properties in addition to the potent alpha-adrenergic effects that it shares with PE. 5 The purpose of this evidence-based practice analysis is to compare NE with PE or ephedrine in regard to their effect on maternal and neonatal hemodynamic outcomes (Heart rate, systolic blood pressure, cardiac output, systemic vascular resistance, APGAR scores, and umbilical cord blood gas).

Logan Meisinger

Author Details

Logan Meisinger, DNAP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Norepinephrine, Phenylephrine, Subarachnoid Block, Spinal Anesthesia, Hypotension, Cesarean

Advisor

Chandler, Holly

Degree

Doctoral-Other

Degree Grantor

Bryan College of Health Sciences

Degree Year

2022

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Review Type

Faculty Approved: Degree-based Submission

Acquisition

Proxy-submission

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