Norepinephrine for the prevention of spinal-induced hypotension during caesarean delivery under combined spinal-epidural anaesthesia: Randomised, double-blind, dose-finding study.
Eur J Anaesthesiol
; 37(4): 309-315, 2020 Apr.
Article
em En
| MEDLINE
| ID: mdl-31977628
ABSTRACT
BACKGROUND:
During caesarean delivery under spinal anaesthesia hypotension may be managed by norepinephrine in preference to phenylephrine due a perception of less bradycardia and fewer reductions in cardiac output.OBJECTIVE:
As the optimum prophylactic dose of norepinephrine is unclear, we aimed to investigate its dose-response for preventing postspinal hypotension in caesarean delivery.DESIGN:
A randomised, double-blinded, dose-finding study.SETTING:
Jiaxing University affiliated Women and Children Hospital, Jiaxing, China. PATIENTS Ninety-nine patients undergoing elective caesarean delivery from 1 February to 5 August excluding patients with ASA III or above, preeclampsia or hypertension, pre-existing or gestational diabetes, BMI more than 35âkgâm, height less than 150âcm or with more than 175âcm, or with contraindications to local anaesthesia.INTERVENTIONS:
Patients received 0, 0.04, 0.05, 0.06 or 0.07âµgâkgâmin preventive norepinephrine infusions immediately after intrathecal injection of 10âmg bupivacaine with 5âµg sufentanil. MAIN OUTCOMEMEASURES:
The norepinephrine (Median effective dose) or (95% effective dose) ED50 and ED95, which were estimated using Probit analysis to compare haemodynamic changes associated with the different doses.RESULTS:
The incidence of hypotension was 70, 47.4, 40, 20 and 15% in the 0, 0.04, 0.05, 0.06 and 0.07âµgâkgâmin groups, respectively. The ED50, ED80 and ED95 values were 0.029 (95% CI 0.008 to 0.042âµgâkgâmin), 0.068 (95% CI 0.055 to 0.099âµgâkgâmin) and 0.105âµgâkgâmin (95% CI 0.082 to 0.172âµgâkgâmin), respectively. Apgar scores or umbilical arterial pH were similar among groups.CONCLUSION:
The ED50, ED80 and ED95 were 0.029, 0.068 and 0.105âµgâkgâmin respectively. A 0.07âµgâkgâmin norepinephrine infusion may be optimum for preventing postspinal hypotension after intrathecal injection of 10âmg bupivacaine combined with 5âµg sufentanil. TRIAL REGISTRATION Chinese Clinical Trial Registry (identifier ChiCTR-TRC-1800014614).
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Hipotensão
/
Hipotensão Controlada
/
Anestesia Epidural
/
Anestesia Obstétrica
/
Raquianestesia
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article