Anesthesiology and Pain Medicine

Published by: Kowsar

Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study

Valiollah Hassani 1 , Gholamreza Movaseghi 2 , Reza Safaeeyan 1 , Sahar Masghati 3 , * , Batool Ghorbani Yekta 4 , 5 and Reza Farahmand Rad 1
Authors Information
1 Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Department of Anesthesiology, Hasheminezhad Hospital, Iran University of Medical Sciences, Tehran, Iran
3 Iran University of Medical Sciences (IUMS), Tehran, Iran
4 Young Researchers and Elite Club, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
5 Herbal Pharmacology Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
Article information
  • Anesthesiology and Pain Medicine: August 2018, 8 (4); e79626
  • Published Online: August 26, 2018
  • Article Type: Research Article
  • Received: May 23, 2018
  • Revised: August 8, 2018
  • Accepted: August 8, 2018
  • DOI: 10.5812/aapm.79626

To Cite: Hassani V, Movaseghi G, Safaeeyan R, Masghati S, Ghorbani Yekta B, et al. Comparison of Ephedrine vs. Norepinephrine in Treating Anesthesia-Induced Hypotension in Hypertensive Patients: Randomized Double-Blinded Study, Anesth Pain Med. 2018 ; 8(4):e79626. doi: 10.5812/aapm.79626.

Copyright © 2018, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Methods
3. Results
4. Discussion
  • 1. Vallejo MC, Attaallah AF, Elzamzamy OM, Cifarelli DT, Phelps AL, Hobbs GR, et al. An open-label randomized controlled clinical trial for comparison of continuous phenylephrine versus norepinephrine infusion in prevention of spinal hypotension during cesarean delivery. Int J Obstet Anesth. 2017;29:18-25. doi: 10.1016/j.ijoa.2016.08.005. [PubMed: 27720613].
  • 2. Vallee F, Passouant O, Le Gall A, Joachim J, Mateo J, Mebazaa A, et al. Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia-induced arterial hypotension. Acta Anaesthesiol Scand. 2017;61(6):590-600. doi: 10.1111/aas.12905. [PubMed: 28543052].
  • 3. Sudfeld S, Brechnitz S, Wagner JY, Reese PC, Pinnschmidt HO, Reuter DA, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017;119(1):57-64. doi: 10.1093/bja/aex127. [PubMed: 28974066].
  • 4. Hess PE. What's new in clinical obstetric anesthesia in 2015? Int J Obstet Anesth. 2017;32:54-63. doi: 10.1016/j.ijoa.2017.03.008. [PubMed: 28684143].
  • 5. Nivatpumin P, Thamvittayakul V. Ephedrine versus ondansetron in the prevention of hypotension during cesarean delivery: a randomized, double-blind, placebo-controlled trial. Int J Obstet Anesth. 2016;27:25-31. doi: 10.1016/j.ijoa.2016.02.003. [PubMed: 27020487].
  • 6. Bauducel M, Piriou V, Dussart C, Aulagner G, Armoiry X. Current trends in vasopressor use to the operating room: A pharmacoepidemiologic study in French teaching and military hospitals. Ann Pharm Fr. 2017;75(4):276-84. doi: 10.1016/j.pharma.2017.02.001. [PubMed: 28347475].
  • 7. Bryant H, Bromhead H. Intraoperative hypotension anaesthesia . Tutorial of the week 148 24th August 2009. world federation of societies of anaesthesiologists; 2009. Available from:
  • 8. Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002;94(4):920-6. table of contents. doi: 10.1097/00000539-200204000-00028. [PubMed: 11916798].
  • 9. Ngan Kee WD, Lee SW, Ng FF, Tan PE, Khaw KS. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015;122(4):736-45. doi: 10.1097/ALN.0000000000000601. [PubMed: 25635593].
  • 10. Smith NT, Corbascio AN. The use and misuse of pressor agents. Anesthesiology. 1970;33(1):58-101. [PubMed: 4393417].
  • 11. Ali Elnabtity AM, Selim MF. Norepinephrine versus Ephedrine to Maintain Arterial Blood Pressure during Spinal Anesthesia for Cesarean Delivery: A Prospective Double-blinded Trial. Anesth Essays Res. 2018;12(1):92-7. doi: 10.4103/aer.AER_204_17. [PubMed: 29628561]. [PubMed Central: PMC5872901].
  • 12. Lecoq JP, Brichant JF, Lamy ML, Joris JL. Norepinephrine and ephedrine do not counteract the increase in cutaneous microcirculation induced by spinal anaesthesia. Br J Anaesth. 2010;105(2):214-9. doi: 10.1093/bja/aeq145. [PubMed: 20576631].
  • 13. Ngan Kee WD, Khaw KS, Tan PE, Ng FF, Karmakar MK. Placental transfer and fetal metabolic effects of phenylephrine and ephedrine during spinal anesthesia for cesarean delivery. Anesthesiology. 2009;111(3):506-12. doi: 10.1097/ALN.0b013e3181b160a3. [PubMed: 19672175].
  • 14. LaPorta RF, Arthur GR, Datta S. Phenylephrine in treating maternal hypotension due to spinal anaesthesia for caesarean delivery: effects on neonatal catecholamine concentrations, acid base status and Apgar scores. Acta Anaesthesiol Scand. 1995;39(7):901-5. doi: 10.1111/j.1399-6576.1995.tb04195.x. [PubMed: 8848889].
  • 15. Kobayashi S, Endou M, Sakuraya F, Matsuda N, Zhang XH, Azuma M, et al. The sympathomimetic actions of l-ephedrine and d-pseudoephedrine: direct receptor activation or norepinephrine release? Anesth Analg. 2003;97(5):1239-45. doi: 10.1213/01.ANE.0000092917.96558.3C. [PubMed: 14570629].
  • 16. Kwak YL, Lee CS, Park YH, Hong YW. The effect of phenylephrine and norepinephrine in patients with chronic pulmonary hypertension*. Anaesthesia. 2002;57(1):9-14. doi: 10.1046/j.1365-2044.2002.02324.x. [PubMed: 11843735].
  • 17. Vos JJ, Poterman M, Hannivoort LN, Renardel De Lavalette VW, Struys MM, Scheeren TW, et al. Hemodynamics and tissue oxygenation during balanced anesthesia with a high antinociceptive contribution: an observational study. Perioper Med (Lond). 2014;3:9. doi: 10.1186/2047-0525-3-9. [PubMed: 25632346]. [PubMed Central: PMC4309299].
  • 18. Pournajafian AR, Ghodraty MR, Faiz SH, Rahimzadeh P, Goodarzynejad H, Dogmehchi E. Comparing GlideScope Video Laryngoscope and Macintosh Laryngoscope Regarding Hemodynamic Responses During Orotracheal Intubation: A Randomized Controlled Trial. Iran Red Crescent Med J. 2014;16(4). e12334. doi: 10.5812/ircmj.12334. [PubMed: 24910788]. [PubMed Central: PMC4028761].
  • 19. Soltani Mohammadi S, Maziar A, Saliminia A. Comparing Clonidine and Lidocaine on Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation in Controlled Hypertensive Patients: A Randomized, Double-Blinded Clinical Trial. Anesth Pain Med. 2016;6(2). e34271. doi: 10.5812/aapm.34271. [PubMed: 27247914]. [PubMed Central: PMC4885122].
  • 20. Ghodraty M, Khatibi A, Rokhtabnak F, Maleki M, Parsa F. Comparing Labetalol and Nitroglycerine on Inducing Controlled Hypotension and Intraoperative Blood Loss in Rhinoplasty: A Single-Blinded Clinical Trial. Anesth Pain Med. 2017;7(5). e13677. doi: 10.5812/aapm.13677. [PubMed: 29696111]. [PubMed Central: PMC5903219].
  • 21. Fathi M, Imani F, Joudi M, Goodarzi V. Comparison Between the Effects of Ringer`s Lactate and Hydroxyethyl Starch on Hemodynamic Parameters After Spinal Anesthesia: A Randomized Clinical Trial. Anesth Pain Med. 2013;2(3):127-33. doi: 10.5812/aapm.7850. [PubMed: 24244923]. [PubMed Central: PMC3821133].
  • 22. Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2004;98(2):483-90. doi: 10.1213/01.ANE.0000096183.49619.FC. [PubMed: 14742392].
  • 23. Ngan Kee WD, Lee SWY, Ng FF, Khaw KS. Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery. Anesth Analg. 2018;126(6):1989-94. doi: 10.1213/ANE.0000000000002243. [PubMed: 28678073].
  • 24. Minzter BH, Johnson RF, Paschall RL, Ramasubramanian R, Ayers GD, Downing JW. The diverse effects of vasopressors on the fetoplacental circulation of the dual perfused human placenta. Anesth Analg. 2010;110(3):857-62. doi: 10.1213/ANE.0b013e3181c91ebc. [PubMed: 20032025].
  • 25. Boccara G, Ouattara A, Godet G, Dufresne E, Bertrand M, Riou B, et al. Terlipressin versus norepinephrine to correct refractory arterial hypotension after general anesthesia in patients chronically treated with renin-angiotensin system inhibitors. Anesthesiology. 2003;98(6):1338-44. [PubMed: 12766641].
  • 26. El Fawy DM, El Shafei MM, El Gendy HA. Norepinephrine versus ephedrine for the prevention of spinal anesthesia-induced hypotension in coronary artery disease patients undergoing knee arthroscopy. Ain Shams J Anaesthesiol. 2015;8(3):424. doi: 10.4103/1687-7934.161723.
  • 27. Moran DH, Perillo M, LaPorta RF, Bader AM, Datta S. Phenylephrine in the prevention of hypotension following spinal anesthesia for cesarean delivery. J Clin Anesth. 1991;3(4):301-5. doi: 10.1016/0952-8180(91)90224-B. [PubMed: 1910798].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments