<![CDATA[Introduction: Spinal anesthesia-induced hypotension (SAIH) remains one of the most frequent hemodynamic complications during spinal anesthesia, particularly among high-risk surgical patients. Vasopressor agents such as phenylephrine and ephedrine are commonly administered to prevent hypotension; however, their comparative effectiveness in maintaining hemodynamic stability remains controversial. This study aimed to analyze the differences between phenylephrine and ephedrine in preventing SAIH among patients undergoing surgery with spinal anesthesia at Haji Adam Malik General Hospital, Medan. Research Methodology: A double-blind randomized clinical trial was conducted between July and September 2023 at Haji Adam Malik General Hospital, Medan. A total of 38 elective surgical patients receiving spinal anesthesia were randomly allocated into two groups: phenylephrine bolus 50 μg (n=19) and ephedrine bolus 5 mg (n=19). Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were measured every 2 minutes for 30 minutes after spinal anesthesia. Data were analyzed using an independent t-test and Mann–Whitney test with a significance level of p<0.05. Results: No statistically significant differences were observed in baseline demographic characteristics between groups (p>0.05). Systolic blood pressure was significantly higher in the ephedrine group at minutes 18–22 after spinal anesthesia (T9–T11) compared with the phenylephrine group (p=0.026; p=0.039; p=0.031, respectively). No significant differences in diastolic blood pressure were found during the observation period (all p > 0.05). Heart rate was significantly higher in the ephedrine group during the first 14 minutes of observation, particularly at T4 and T5 (90.6±11.2 vs 73.3±17.3 bpm; p=0.001 and 90.3±8.6 vs 71.0±14.5 bpm; p=0.001). Conclusion: Phenylephrine and ephedrine demonstrated comparable effectiveness in maintaining systolic and diastolic blood pressure during spinal anesthesia. However, ephedrine was associated with a significantly greater heart rate response than phenylephrine. Phenylephrine may therefore be considered a preferable option for preventing SAIH in patients requiring more stable heart rate control]]>
