Vasopressor therapy for hypotension due to epidural anesthesia for cesarean section

Maternal hemodynamic changes and neonatal acid-base status were assessed in 127 healthy patients undergoing elective cesarean section under epidural anesthesia. An impedance cardiograph was used to measure stroke volume (SV), ejection fraction (EF) and end-diastolic volume (EDV). In addition, neonatal umbilical venous and arterial PO2, PCO2, pH, base excess, lactate, pyruvate, excess lactate, and L/P ratio were measured at birth. Patients were divided into three groups. Group 1 (n = 53) required no vasopressor (normotensive controls). In Group 2 (n = 37), mean blood pressure (BP) decreased from 90 mmHg (13.3 kPa). In Group 3 (n = 37), BP decreased from 83 mmHg to 62 mmHg (11.1 to 8.2 kPa), and phenylephrine was administered in 100 micrograms increments to maintain systolic BP greater than 100 mmHg (13.3 kPa). In Groups 2 and 3 the SV and EDV decreased 43% and 33% respectively when hypotension developed. Both vasopressors restored BP, SV and EDV to near baseline values. Neonatal Apgar scores and acid-base profiles were not significantly different among the three groups of neonates, nor were they different between the two hypotensive groups. It is concluded that: 1) transient maternal hypotension does not affect neonatal acid-base status; 2) both ephedrine and phenylephrine increase cardiac preload; and 3) an alpha agent like phenylephrine does not cause fetal acidosis when used for treating maternal hypotension.