Ali Mirmansouri, Farnoush Farzi, Azadeh Raouf, Ziba Zahiri Sorouri, Fereidon Mortazavi Najafabadi.
Epinephrine; a vasoconstrictor or a uterine relaxant? a case series.
Professional Med J Jan ;23(04):504-8.

The most common complication of spinal anesthesia for cesarean section is hypotension. Ephedrine is the most commonly used vasopressor that increases blood pressure with minimal impact on uteroplacental blood flow. An alpha-1 adrenergic receptor agonist may need to be administrated when ephedrine is ineffective. Unavailability of alpha-1 receptor agonists in a period of time in our center leads to administration of epinephrine as the second drug. In the present study, the data of 14 patients with ephedrine resistant hypotension during spinal anesthesia for cesarean section were reviewed. Increase in maternal blood pressure was recorded one minute after epinephrine administration in all patients. Surprisingly, this medication also causes uterine relaxation after one to five minutes. Ease of fetal extraction was noticed in 13 patients. All patients achieved adequate uterine contraction after delivery. Epinephrine helped regulate blood pressure and surprisingly facilitate uterine relaxation in patients with emergency cesarean section with spinal anesthesia.

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