Background and Aims This study aimed to investigate whether the addition of a fixed rate phenylephrine infusion or noradrenaline infusion to a colloid co-hydration regimen results in better maternal hemodynamic status as compared to the administration of colloids alone without any vasoconstrictor during elective cesarean section under combined spinal-epidural anesthesia

Methods 120 parturients were randomized to either phenylephrine 50 μg/min (group P) or noradrenaline 4 μg/min (group N) or placebo (group C). As soon as the spinal injection started, all groups were administered 10 mL/kg of hydroxyethyl starch solution simultaneously with the onset of vasoconstrictor infusion. The primary end-point of the study was the incidence of maternal hypotension (SAP<80% of baseline)

Results The incidence of maternal hypotension was higher in group C than in both groups P and N (p=0.011 and p<0.001, respectively). The incidence of bradycardia was higher in group P than in group N (p=0.018). The incidence of reactive hypertension was higher in group P than in both groups N and C (p=0.029 and 0.005, respectively).The need of modification of the infusion rate was higher in group P than in both groups N and C (p<0.001 και p=0.002, respectively). Post-delivery Apgar scores were similar in all groups

Conclusions The combination of a fixed-rate infusion of noradrenaline with the co-administration of colloid seems to be the most effective in the management of the parturient during cesarean section, being superior to either a combination of colloid co-administration with a fixed rate of phenylephrine or to the administration of colloid alone without any vasoconstrictor agent