ORIGINAL ARTICLE
Year : 2013  |  Volume : 7  |  Issue : 1  |  Page : 36-40

The role of sildenafil in perioperative management of parturients with pulmonary hypertension undergoing cesarean section


Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Nevan El-Mekawy
MD, Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Cairo University, 11516 Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJCA.0000431538.57283.58

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Objective

This study was carried out to evaluate the effects of sildenafil in perioperative management of parturients with pulmonary hypertension undergoing cesarean section in Kasr El Aini hospitals.

Patients and methods

Twenty-four parturients subjected to elective cesarean section were anesthetized with epidural anesthesia. Incremental doses (5 ml) of lidocaine (1%) and bupivacaine (0.25%) mixture (up to 20 ml) were administered to attain sensory block at the T4 level. Patients were randomized to receive either oral sildenafil 50 mg 1 h before anesthesia and then 25 mg three times daily postpartum for 1 month (sildenafil group) (n=12 patients) or placebo tablets (control group) (n=12 patients). An epicardial transthoracic echocardiography was performed postoperatively daily for 3 days and then after 1 month to obtain information on pulmonary blood pressure and ejection fraction (EF), hemodynamic parameters, and arterial blood gases analysis, and maternal and neonatal outcomes were compared between the groups.

Results

There were no significant differences in mean arterial pressure and heart rate between the two groups or from the baseline. The sildenafil group showed a significant improvement in maternal oxygenation and the pulmonary artery pressure (PAP) decreased from 47.33±6.80 to 34.50±4.92 mmHg after 1 month of treatment. In the sildenafil group, EF increased from 56.00±1.95 to 62.83±3.80% after 1 month. However, in the control group, there were no statistically significant changes in maternal oxygenation, PAP, or EF. There were no significant differences between the two groups in neonatal outcomes using the APGAR score at 1 and 5 min.

Conclusion

The use of oral sildenafil has promising results in parturient with pulmonary hypertension as it is effective in improving maternal oxygenation, decreasing PAP, and increasing EF.



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