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Tan H, Chen Y, Jiang Y, Sun X, Ye W, Zhu X, Xiong X. Determination of ED90s of Phenylephrine and Norepinephrine Infusion for Prevention of Spinal Anesthesia-Induced Hypotension in Patients with Preeclampsia During Cesarean Delivery. Drug Des Devel Ther 2024; 18:2813-2821. [PMID: 38984209 PMCID: PMC11232882 DOI: 10.2147/dddt.s467072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
Background Vasopressors remain an important strategy for managing spinal anesthesia-induced hypotension in women with preeclampsia. The aim of this study was to investigate the ED90s and efficacy ratio of phenylephrine and norepinephrine in managing spinal anesthesia-induced hypotension in women with preeclampsia during cesarean delivery. Methods 60 women with preeclampsia, who underwent cesarean delivery, were randomly assigned to receive either a continuous intravenous infusion of phenylephrine or norepinephrine following spinal anesthesia. The initial dosage of phenylephrine or norepinephrine for the first women was 0.5 or 0.05 μg/kg/min, respectively, and subsequent infusion dosages were adjusted based on their efficacy in preventing spinal anesthesia-induced hypotension (defined as a systolic blood pressure less than 80% of the baseline level). The incremental or decremental doses of phenylephrine or norepinephrine were set at 0.1 or 0.01 μg/kg/min. The primary outcomes were the ED90s and efficacy ratio of phenylephrine and norepinephrine infusions for preventing spinal anesthesia-induced hypotension prior to delivery. Results The results obtained from isotonic regression analysis revealed that the ED90 values of the phenylephrine and norepinephrine group for preventing spinal anesthesia-induced hypotension were 0.597 (95% CI: 0.582-0.628) and 0.054 (95% CI: 0.053-0.056) μg/kg/min, respectively, with an efficacy ratio of 11.1:1. The results of Probit regression analysis revealed that the ED90 values were determined to be 0.665 (95% CI: 0.576-1.226) and 0.055 (95% CI: 0.047-0.109) μg/kg/min, respectively, with an efficacy ratio of 12.1:1. Conclusion The administration of 0.6 μg/kg/min phenylephrine and 0.05 μg/kg/min norepinephrine has been found to effectively manage a 90% incidence of spinal anesthesia-induced hypotension in women with preeclampsia.
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Affiliation(s)
- Haijie Tan
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
| | - Yi Chen
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, Yinchuan, People's Republic of China
| | - Yan Jiang
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
| | - Xiaojing Sun
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
| | - Wei Ye
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
| | - Xuefang Zhu
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
| | - Xiangsheng Xiong
- Department of Anesthesiology, The Fifth People's Hospital of Huaian, Huaian, People's Republic of China
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Chen Y, Guo L, Qin R, Xi N, Wang S, Ma Y, Ni X. Dose-Response Study of Norepinephrine Infusion for Maternal Hypotension in Preeclamptic Patients Undergoing Cesarean Delivery Under Spinal Anesthesia. Clin Pharmacokinet 2024; 63:847-856. [PMID: 38869701 DOI: 10.1007/s40262-024-01381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND OBJECTIVE Spinal anesthesia remains the preferred mode of anesthesia for preeclamptic patients during cesarean delivery. We investigated the incidence of maternal hypotension under spinal anesthesia during cesarean delivery, by comparing different prophylactic infusion rates of norepinephrine with normal saline. METHODS We randomly allocated 180 preeclamptic patients (45 in each groups) aged 18-45 scheduled for cesarean delivery to receive one of four prophylactic norepinephrine infusions at doses of 0 (normal saline group), 0.025 (0.025 group), 0.05 (0.05 group), or 0.075 (0.075 group) µg/kg/min following spinal anesthesia. The primary endpoint was the incidence of maternal hypotension (systolic blood pressure < 80% of baseline). RESULTS The incidence of maternal hypotension was reduced with different prophylactic infusion rates of norepinephrine (26.7%, 15.6%, and 6.7%) compared with normal saline (37.8%) with a significant decreasing trend (p = 0.002). As the infusion doses of norepinephrine increased, there is a significant decreasing trend in deviation of systolic blood pressure control (median performance error; median absolute performance error) from baseline (p < 0.001; p < 0.001) and need for rescue norepinephrine boluses (p = 0.020). The effective dose 50 and effective dose 90 of prophylactic norepinephrine infusion were - 0.018 (95% confidence interval - 0.074, 0.002) µg/kg/min and 0.065 (95% confidence interval 0.048, 0.108) µg/kg/min, respectively. CONCLUSIONS Prophylactic infusion of norepinephrine, as compared to no preventive measures, can effectively reduce the incidence of maternal hypotension in preeclamptic patients under spinal anesthesia during cesarean delivery, without increasing other adverse events for either the mother or neonate. REGISTRATION Clinical trials.gov identifier number NCT04556370.
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Affiliation(s)
- Yi Chen
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Lei Guo
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Rui Qin
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Nan Xi
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Shengfu Wang
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Yujie Ma
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China
| | - Xinli Ni
- Department of Anesthesiology and Perioperative Medicine, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, Ningxia 750004, China.
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Hashemian M, Barouni M, Honarvar Z, Alidousti K, Mohajerani SA, Rezaeizadeh L. Comparison of Ropivacaine versus Bupivacaine in Spinal-Induced Hypotension in Preeclampsia Patients: A Randomized Control Trial. Anesth Pain Med 2024; 14:e142646. [PMID: 38737589 PMCID: PMC11088844 DOI: 10.5812/aapm-142646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 05/14/2024] Open
Abstract
Background Spinal anesthesia is considered to be the safest method of anesthesia for cesarean sections in patients with preeclampsia. Patients with preeclampsia are at an increased risk of experiencing severe hypotension following spinal anesthesia, which could have more profound and deleterious effects on both the fetus and the mother. However, bupivacaine, the most commonly used drug, can induce severe hypotension even at low doses. The purpose of this study is to minimize post-spinal hypotension in both the mother and the fetus. Objectives To determine and compare the reduction in hypotension following spinal anesthesia in patients with preeclampsia between the ropivacaine and bupivacaine groups. Methods In a randomized clinical trial, a total of 90 parturients with preeclampsia undergoing spinal anesthesia were enrolled and randomly divided into 2 groups: One receiving ropivacaine and the other receiving bupivacaine. The dose of spinal ropivacaine was 15 mg of a 0.5% solution, and the dose of bupivacaine was also 15 mg of a 0.5 % solution. Hemodynamic parameters, including systolic and diastolic blood pressure and heart rate, were recorded following the administration of spinal anesthesia. Pain scores and the time until the return of motor movement were also documented. Results For statistical analysis, the t-test, Chi-square, and ANOVA tests were utilized to compare the groups. Demographic variables, including maternal age, gestational age, parity, and gravidity, were not significantly different between the 2 groups. The trend of mean systolic blood pressure (SBP) was significantly lower in the bupivacaine group compared to the ropivacaine group at all measured time points in the study (P < 0.05). The amount of ephedrine used after spinal anesthesia was significantly different at 2 and 4 minutes in the ropivacaine group compared to the bupivacaine group (P = 0.012, P = 0.025). Post-operative pain scores at 1 hour in recovery were not significantly different between the ropivacaine and bupivacaine groups (P = 0.015). The time to knee movement was also significantly shorter in the ropivacaine group compared to the bupivacaine group (P < 0.001). Conclusions Ropivacaine reduces the incidence of hypotension in spinal anesthesia compared to bupivacaine for cesarean section in patients with preeclampsia. This is attributed to a lower occurrence of spinal-induced hypotension, improved hemodynamic control, reduced ephedrine usage, and faster patient ambulation. A future study could focus on investigating different dosages of both drugs with a larger number of participants.
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Affiliation(s)
- Morteza Hashemian
- Department of Anesthesiology and Pain Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Barouni
- Research Center for Health Services Management, Institute for Future Studies in Health, Kerman, Iran
| | - Zahra Honarvar
- Department of Obstetrics and Gynecology, Kerman University of Medical Sciences, Kerman, Iran
| | - Katayoun Alidousti
- Department of Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Amir Mohajerani
- Department of Anesthesiology and Pain Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Rezaeizadeh
- Department of Anesthesiology and Pain Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Al Moosa AM, Burad J, Jose S, Al Jabri RM. A Five-Year Retrospective Closed Cohort Study to Find a Superior Anaesthetic Technique for Caesarean Section From a Haemodynamic Perspective. Cureus 2023; 15:e51000. [PMID: 38259405 PMCID: PMC10802923 DOI: 10.7759/cureus.51000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Background A cesarean section (CS) is common and requires a safe and effective anesthetic technique for the safety of both the mother and the fetus. This study aims to compare the intraoperative hemodynamic safety profile with general anesthesia (GA) and regional anesthesia (RA) and propose a superior technique for cesarean from the hemodynamic perspective. Methods After obtaining ethical committee approval, a retrospective closed cohort study was conducted on patients who underwent cesarean with GA and RA. This study was conducted at a tertiary-level university hospital in Oman from January 2015 to December 2019. The investigators collected maternal and fetal data (hypotension, bradycardia, blood loss, APGAR score, fetal mortality, complications, and length of stay) from January 2015 to December 2019. The primary outcome was the incidence of intraoperative hypotension, and the secondary outcomes studied were significant blood loss and APGAR score in both anesthesia techniques. Results A total of 2500 cesarean patients were studied, of whom 1379 received RA and 1121 received GA. The overall hypotension (systolic BP<90 mm Hg) rate observed was 40.1%; it was significantly lower with GA as compared to RA (32.1% versus 46.5%, respectively, P<0.001, OR 0.545, 95% CI 0.462 to 0.643). Consequently, the requirement for vasopressors was low with GA compared to RA (1.6% versus 23.1%, P<0.001, OR 0.054, 95% CI 0.034 to 0.088). Blood loss (>1 L) was remarkably higher in GA as compared to the RA (15.5% versus 8.9%, respectively, P<0.001, OR 1.916, 95% CI 1.499 to 2.448). APGAR scores were lower with GA than RA (2.8% versus 0.9%, P<0.001). Bradycardia and fetal mortality were almost equal in both groups. Conclusion GA is associated with significantly better hemodynamic stability during the cesarean section.
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Affiliation(s)
- Al Muayad Al Moosa
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
| | - Jyoti Burad
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
| | - Sachin Jose
- Statistics, Oman Medical Speciality Board, Muscat, OMN
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Belachew BG, Kasahun B, Demissie BW, Sintayhu A, Dendir G, Ali A, Awol R, Angasa D, Tasew A, Eshatu O, Desta AB, Girma D, Debalke G. Comparison of the hemodynamic changes between preeclamptic and normotensive parturients who underwent cesarean section under spinal anesthesia at North Showa zone public hospitals, Oromia region, Ethiopia, 2022: a prospective cohort study. BMC Anesthesiol 2023; 23:387. [PMID: 38007422 PMCID: PMC10675935 DOI: 10.1186/s12871-023-02314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/20/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Spinal anaesthesia complicates maternal hemodynamic and may expose the parturient to dangerous cardiovascular problems. Up to 7% to 89.2% of pregnant women can suffer from spinal anaesthesia-related hypotension. The aim of this study to compare the hemodynamic changes between preeclamptic and normotensive parturients who underwent caesarean section under spinal anaesthesia at North Showa Zone Public Hospitals, Oromia Region, from February 15 to May 15, 2022. METHODS A prospective cohort study was conducted on a total of 140 parturients (70 in each group) who underwent cesarean delivery under spinal anesthesia. The study participants were chosen using a consecutive sampling technique. Data were collected from patient charts and intraoperative observations and entered into the Epi Data software version 4.6 and exported to the Statistical Package for the Social Sciences version 25 software. Hemodynamic change = (baseline value-current value/baseline value) * 100. The independent t-test, Mann-Whitney U test, two ways mixed ANOVA, chi-square, and Fisher's exact test was used to analyze the data as appropriate. A P < 0.05 was statistically significant. RESULTS The mean percentage change in SBP, DBP, and MAP after spinal anaesthesia was a statistically significant difference between the normotensive and preeclamptic groups, except MAP at 15 min was comparable between the two groups with p = 0.638. The proportion of preeclamptic parturients who develop hypotension was 47%, compared to 74% of normotensive parturients, and the RR of developing hypotension, if participants were preeclamptic, was 0.63, with a 95% confidence interval of 0.412 to 0.978 and a p = 0.039. The mean change in heart rate during the first 15 min was comparable between the groups. CONCLUSION In contrast to normotensive parturients undergoing caesarean section under spinal anaesthesia, our study found that the hemodynamic change was lower in preeclamptic parturients. The proportion of preeclamptic women who develop hypotension was 47%, compared to 74% of normotensive parturients.
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Affiliation(s)
| | - Blen Kasahun
- School of Anaesthesia, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Birhanu Wondimeneh Demissie
- School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
- Faculty of Health, School of Nursing & Midwifery, University of Technology Sydney, Sydney, Australia
| | - Ashagrie Sintayhu
- School of Anaesthesia, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getahun Dendir
- School of Anaesthesia, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abas Ali
- Department of Anaesthesia, Worabe University, Worabe, Ethiopia
| | - Redi Awol
- School of Anaesthesia, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Dugo Angasa
- Department of Anaesthesia, Hawasa University, Hawasa, Ethiopia
| | - Asaminew Tasew
- Department of Anaesthesia, Ambo University, Ambo, Ethiopia
| | - Oliyad Eshatu
- Department of Anaesthesia, Hawasa University, Hawasa, Ethiopia
| | | | - Derara Girma
- Public Health Department, College of Health Sciences, Salale University, Fiche, Ethiopia
| | - Getachew Debalke
- Department of Anaesthesia, College of Health Sciences, Arsi University, Asella, Ethiopia
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Hu LJ, Mei Z, Shen YP, Sun HT, Sheng ZM, Chen XZ, Qian XW. Comparative Dose-Response Study of Phenylephrine Bolus for the Treatment of the First Episode of Spinal Anesthesia-Induced Hypotension for Cesarean Delivery in Severe Preeclamptic versus Normotensive Parturients. Drug Des Devel Ther 2022; 16:2189-2198. [PMID: 35837022 PMCID: PMC9275428 DOI: 10.2147/dddt.s368480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Li-Juan Hu
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhong Mei
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Yan-Ping Shen
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Hao-Tian Sun
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhi-Min Sheng
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xin-Zhong Chen
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiao-Wei Qian
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Correspondence: Xiao-Wei Qian, Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Road 1, Hangzhou, 310006, People’s Republic of China, Tel +86-571-87061501, Fax +86 571 87061878, Email
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Tamiru SM, Bantie AT. Comparison of hemodynamic changes and fetal outcome between normotensive and preeclamptic parturient undergoing elective cesarean section under spinal anesthesia: A prospective observational cohort study. Ann Med Surg (Lond) 2022; 78:103829. [PMID: 35734730 PMCID: PMC9206909 DOI: 10.1016/j.amsu.2022.103829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 10/31/2022] Open
Abstract
Background Objective Methodology Results Conclusion Peak sensory block level was similar in both groups and no patients complained intraoperative pain and analgesics were not required supplemental. Base line SBP, DBP and MAP were significantly higher in severe preeclamptic group (p = 0.01). Mean gestational age of the fetus was significantly low in severe preeclamptic group (p = 0.01). Apgar score at 1st min(7–8 vs,8–9),volume of intra operative fluid use were statistically significant with p < 0.05
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Guo L, Qin R, Ren X, Han C, Xue W, He L, Ma L, Pan H, Ma S, Chen Y, Ni X. Prophylactic norepinephrine or phenylephrine infusion for bradycardia and post-spinal anaesthesia hypotension in patients with preeclampsia during Caesarean delivery: a randomised controlled trial. Br J Anaesth 2022; 128:e305-e307. [DOI: 10.1016/j.bja.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/23/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022] Open
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Maternal and neonatal outcomes of preeclamptic and normotensive women who underwent cesarean section under spinal anesthesia: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nikooseresht M, Seifrabiei MA, Hajian P, Khamooshi S. A Clinical Trial on the Effects of Different Regimens of Phenylephrine on Maternal Hemodynamic After Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2020; 10:e58048. [PMID: 33134140 PMCID: PMC7539049 DOI: 10.5812/aapm.58048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 05/05/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.
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Affiliation(s)
- Mahshid Nikooseresht
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Pouran Hajian
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shadab Khamooshi
- Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding Author: Department of Anesthesiology, Hamadan University of Medical Sciences, Be'sat Hospital, Resalat Sq., Motahari Blvd., Postal Code: 65148-45471, Hamadan, Iran.
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Alemayehu TY, Berhe YW, Getnet H, Molallign M. Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study. Patient Saf Surg 2020; 14:9. [PMID: 32266010 PMCID: PMC7110765 DOI: 10.1186/s13037-020-00234-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Spinal anesthesia-induced maternal hypotension is the most frequent complication associated with maternal morbidity and mortality during Cesarean section. The aim of this study was to compare the incidence and magnitude of hemodynamic changes in preeclamptic and non-preeclamptic parturients undergone Cesarean section under spinal anesthesia. Method A prospective cohort study was conducted from 01 February to 28 May 2019 in preeclamptic and non-preeclamptic parturients. We hypothesized preeclamptic parturients are at high risk of spinal anesthesia induced hypotension than non preeclamptics. A total of 122 ASA II and ASA III parturients were recruited consecutively and assigned to two groups (81non-preeclamptics, and 41 preeclamptics). Parturients with cardiac disease, twin pregnancy, chronic hypertension, gestational hypertension, superimposed hypertension, renal disease, diabetes mellitus, coagulopathy (platelet count < 80 × 109/L), active labor, eclampsia, abruptio placentae, placenta praevia, any adjuvant added with local anesthetics were excluded. The data analysis was done using SPSS version 22 statistical software. Student t test, MannWhitney U test and Fisher exact test were used to compare the data. All P values < 0.05 were considered statistically significant. Result The incidence of spinal anesthesia-induced hypotension was higher in non-preeclamptic parturients than preeclamptic parturients (55.6% vs. 34.1%, respectively) and the degree of blood pressure drop was significantly greater in the non-preeclamptic parturients compared to those with preeclampsia; As well intraoperative fluid consumption was significantly greater in the non-preeclamptics parturients compared to those with preeclamptics. Conclusion The incidence and magnitude of spinal anesthesia-induced hypotension in parturients undergone Cesarean section were less in preeclamptic parturients than in non-preeclamptic parturients.. Based on the data from this study we recommended spinal anesthesia for preeclamptic patients, unless there is a contra indication based on preeclampsia.
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Affiliation(s)
| | | | - Habtamu Getnet
- 2Department of anesthesia, Univesity of Gondar, Gondar, Ethiopia
| | - Mamaru Molallign
- 2Department of anesthesia, Univesity of Gondar, Gondar, Ethiopia
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Sivevski A, Ivanov E, Karadjova D, Slaninka-Miceska M, Kikerkov I. Spinal-Induced Hypotension in Preeclamptic and Healthy Parturients Undergoing Cesarean Section. Open Access Maced J Med Sci 2019; 7:996-1000. [PMID: 30976348 PMCID: PMC6454163 DOI: 10.3889/oamjms.2019.230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There is a widespread belief that spinal anaesthesia in patients with preeclampsia might cause severe hypotension and decreased uteroplacental perfusion. This study aimed to evaluate the incidence and severity of spinal induced-hypotension in preeclamptics and healthy parturients. METHODS Total of 78 patients (40 healthy and 38 preeclamptic) undergoing a C-Section with spinal anaesthesia were included. Spinal anaesthesia was performed with a mixture of 8-9 mg isobaric 0.5% bupivacaine, 20 mcg fentanyl and 100 mcg morphine (total volume 2.2-2.4 ml). Blood pressures (BP)-SBP, DBP, MAP were recorded non-invasively before performing spinal anaesthesia and at 2.5 minutes after a spinal puncture. RESULTS The BP falls (%) from baseline were significantly greater in the healthy parturients compared to those with preeclampsia (25.8% ± 10.1 vs 18.8% ± 17.0 for SBP, 28.5% ± 8.8 vs 22.5% ± 10.4 for DBP, and 31.2% ± 14.2 vs 18.2% ± 12.6% for MAP, p < 0.05). The incidence rate of hypotension in the preeclamptics was 25% compared to 53% in healthy parturients (p < 0.001). Higher doses of vasopressors both ephedrine (16.5 ± 8.6 vs 6.0 ± 2.0 mg) and phenylephrine (105 ± 25 mg) in the healthy women were required. There was no need for phenylephrine treatment in the preeclamptic group. CONCLUSION This study showed that the incidence and severity of spinal-induced hypotension in preeclamptic patients are less than in healthy women. The use of low dose spinal anaesthesia also contributed to this statement.
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Affiliation(s)
- Atanas Sivevski
- University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Emilija Ivanov
- University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Dafina Karadjova
- University Clinic for Gynecology & Obstetrics, Anaesthesia Department, Clinical Center Mother Teresa, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Maja Slaninka-Miceska
- Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Igor Kikerkov
- Institute of Preclinical and Clinical Pharmacology and Toxicology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Heesen M, Rijs K, Hilber N, Ngan Kee W, Rossaint R, van der Marel C, Klimek M. Ephedrine versus phenylephrine as a vasopressor for spinal anaesthesia-induced hypotension in parturients undergoing high-risk caesarean section: meta-analysis, meta-regression and trial sequential analysis. Int J Obstet Anesth 2019; 37:16-28. [DOI: 10.1016/j.ijoa.2018.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 10/01/2018] [Accepted: 10/13/2018] [Indexed: 11/28/2022]
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El-Tahan MR, El Kenany S, Abdelaty EM, Ramzy EA. Comparison of the effects of low doses of dexmedetomidine and remifentanil on the maternal hemodynamic changes during caesarean delivery in patients with severe preeclampsia: a randomized trial. Minerva Anestesiol 2018. [PMID: 29516705 DOI: 10.23736/s0375-9393.18.12312-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preoperative remifentanil administration blunts hemodynamic responses to tracheal intubation in parturients with severe preeclampsia. We hypothesized that the preoperative administration of low doses of remifentanil or dexmedetomidine would lead to comparable maternal neurohormonal responses and neonatal outcomes in patients with severe preeclampsia. METHODS Parturients diagnosed with severe preeclampsia undergoing caesarean delivery were randomLy allocated to receive remifentanil (0.1 µg/kg/min) or dexmedetomidine (0.4 µg/kg/h) at five min and 20 min before induction, respectively. Changes in maternal mean arterial BP(MAP), clinical recovery, cortisol level, and neonatal outcome, were recorded. RESULTS Patients who received remifentanil had higher response in MAP at the induction (94 9.8 vs. 104 4.5; P<0.001) and emergence from anesthesia (94 6.3 vs. 98 5.1; P<0.001), but shorter times to extubation (5.1 1.6 vs. 13.5 2.8 min; P<0.001). Five (27.8%) patients in the remifentanil group received ephedrine versus none in the dexmedetomidine group (P=0.023). The maternal plasma cortisol levels, the neonatal Neurologic and Adaptative Capacity Scores and acid-base satuses were similar in the two groups. Newborns in the remifentanil group presented lower Apgar scores at 1 minute (5.11 0.8 vs. 5.68 0.8; P=0.034) and a higher incidence of respiratory depression (72.2% vs. 36.8% P=0.048). CONCLUSIONS Compared with dexmedetomidine (0.4 µg/kg/h), the preoperative administration of remifentanil (0.1 µg/kg/min) produced a significantly higher effect on maternal hemodynamic responses to caesarean delivery in patients with severe preeclampsia, however maternal hypotension and neonatal respiratory depression were more common with the use of remifentanil.
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Affiliation(s)
- Mohamed R El-Tahan
- Department of Anesthesiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khubar, Saudi Arabia -
| | - Samah El Kenany
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura City, Egypt
| | - Ehsan M Abdelaty
- Department of Clinical Pathology, College of Medicine, Mansoura University, Mansoura City, Egypt
| | - Eiad A Ramzy
- Department of Anesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansoura City, Egypt
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15
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Ulubaşoğlu H, Bakay K, Güven D. Relation with postpartum maternal morbidity of different types of anesthesia in preeclamptic patients. Hypertens Pregnancy 2017; 37:25-29. [PMID: 29157041 DOI: 10.1080/10641955.2017.1402923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study is to investigate the effect of different anesthesia types administered to patients with preeclampsia on postoperative maternal morbidities. METHODS Medical records of pregnant women complicated with preeclampsia delivered by cesarean from January 2010 to December 2016 in our clinic were retrospectively reviewed. RESULTS There was not a statistically significant difference between patients receiving spinal anesthesia and general anesthesia in terms of additional parenteral analgesic requirement at postoperative period (p = 0.520). The length of stay in hospital and δHb (preoperative hemoglobin value minus postoperative hemoglobin value) were not different between spinal anesthesia and general anesthesia groups (p = 0.140 and 0.648, respectively). The rate of postoperative antihypertensive medication requirement was statistically significant in patients with severe preeclampsia who underwent general anesthesia (p = 0.009, x2 = 6.867, odds ratios = 4.276 (1.531-11.942)). The time passing to reach the first normal blood pressure level in patients with severe preeclampsia was 11.95 ± 9.11 h in patients with spinal anesthesia, 10.55 ± 4.95 h in patients with general anesthesia, and the difference was not statistically significant (p = 0.504). CONCLUSION The need for antihypertensive medication is greater in patients with severe preeclampsia receiving general anesthesia. There is a need for comprehensive, prospective, and randomized controlled trials to establish the relationship between postpartum morbidity and the different types of anesthesia.
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Affiliation(s)
- Hasan Ulubaşoğlu
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
| | - Kadir Bakay
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
| | - Davut Güven
- a Department of Obstetrics and Gynecology, Faculty of Medicine , Ondokuz Mayis University , Samsun , Turkey
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Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol 2017. [DOI: 10.1016/j.bpa.2016.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Dusitkasem S, Herndon BH, Somjit M, Stahl DL, Bitticker E, Coffman JC. Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review. Front Med (Lausanne) 2017; 4:2. [PMID: 28164084 PMCID: PMC5247437 DOI: 10.3389/fmed.2017.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. Source An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms “ephedrine and phenylephrine,” “preterm and term and spinal hypotension,” “preeclampsia and healthy parturients,” or “multiple and singleton gestation and vasopressor.” Society of Obstetric Anesthesia and Perinatology meeting abstracts for the past 4 years were also searched for relevant studies. Principle findings Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. Conclusion From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency.
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Affiliation(s)
- Sasima Dusitkasem
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Blair H Herndon
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Monsicha Somjit
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Srinagarin Hospital, Khonkaen University, Khon Kaen, Thailand
| | - David L Stahl
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Emily Bitticker
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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