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To avoid bias, randomization was stratified by using a separate set of randomization envelopes for each of the standard spinal anesthetic techniques. Technique 2: 2 ml of spinal levobupivacaine 0. Technique 3: 2 ml of spinal levobupivacaine 0. The height of neural blockade to cold sensation was measured using ethyl chloride spray at 10-min postspinal and at skin incision. The target block height was above T5. An epidural top-up, using 0. Immediately following the spinal injection the infusion of intravenous vasopressor solution was started, using a Graseby Medical 3400 Anesthesia Pump (Graseby Medical Limited, Colonial Way, Watford, Herts, WD2 4LG, United Kingdom), and adjusted according to a standard protocol.

The patients were then placed in the supine position with standard left lateral tilt. Systolic arterial pressure and heart rate were measured every minute following spinal anesthesia using the same automated oscillometer that was used for the baseline blood pressure. The trial solution was given via a Y-connector into the same intravenous cannula as the Hartmann solution.

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P Forty-eight patients were studied in the phenylephrine group, 50 in the ephedrine group and 49 in the combination group. It was not possible to study blood gases for four fetuses: In three (two ephedrine group and one combination group) arterial and venous samples were almost identical, suggesting that both were either arterial or venous, and in one (combination group), it was not possible to obtain umbilical blood samples.

These four patients were included for analysis of other variables. The groups were well matched for age, height, weight, gestation, breech presentation, previous cesarean delivery, and birth weight (table 1). The trial infusions were controlled, and all data were collected by one of four investigators (table 2). Results are expressed as median (IQR). The systolic arterial pressure was also similar over time for the three groups (fig.

However, there was a small but statistically significant difference between 20 and 25 min postspinal anesthesia when the mean systolic arterial pressure was lower in the phenylephrine group than in the ephedrine and combination groups (fig. The incidence of hypotension (systolic arterial pressure table 3).

The code had to be broken for two patients in the ephedrine group who had a systolic arterial pressure less than 0. Mean systolic arterial pressure during spinal anesthesia for the phenylephrine group (open bar), the ephedrine group (shaded bar) and the combination group (cross-hatched bar).

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