Comparison of Vasopressor Boluses for Management of Hypotension After Spinal Anesthesia
Overview
- Phase
- Phase 4
- Intervention
- Norepinephrine 6 mcg
- Conditions
- Cesarean Section Complications
- Sponsor
- Cairo University
- Enrollment
- 86
- Locations
- 1
- Primary Endpoint
- Rate of successful management of maternal hypotension
- Last Updated
- 4 years ago
Overview
Brief Summary
In this study the investigators will compare the efficacy and side effects of two doses of norepinephrine bolus (6 mcg and 10 mcg) in management of maternal hypotensive episode after subarachnoid block during Cesarean delivery.
Detailed Description
Maternal hypotension after subarachnoid block is a frequent and deleterious complication during cesarean delivery. Although prophylaxis against hypotension using vasopressors had become a standard recommendation; the incidence of hypotension is still ∼ 20% . Thus; management of maternal hypotension using vasopressor boluses is usually needed . The commonly used vasopressors during cesarean delivery are ephedrine, phenylephrine, and recently norepinephrine. The use of ephedrine is usually accompanied with maternal tachycardia and fetal acidosis. Phenylephrine had been the first line for prevention and management of maternal hypotension; however, its use might result in bradycardia and decreased maternal cardiac output . Norepinephrine is an alpha adrenergic agonist with weak beta adrenergic agonistic activity; thus, it does not cause significant cardiac depression as phenylephrine does. Norepinephrine was introduced for use during cesarean delivery with promising results . Few previous studies investigated the efficacy of Norepinephrine infusion for prevention of maternal hypotension. A dose-response study had investigated the best dose of Norepinephrine for prevention of maternal hypotension. In the aforementioned dose-response study, a dose of 6 mcg was reported as the best dose for prophylaxis against maternal hypotension. No studies had investigated the best bolus dose of norepinephrine for management of a maternal hypotensive episode. In this study the investigators will investigate the efficacy and side effects of two doses of norepinephrine bolus doses (6 mcg and 10 mcg) in management of maternal hypotensive episode after subarachnoid block during cesarean delivery.
Investigators
Ahmed Hasanin
Assistant professor of anesthesia and critical care
Cairo University
Eligibility Criteria
Inclusion Criteria
- •pregnant women
- •scheduled for cesarean delivery
Exclusion Criteria
- •patients with severe cardiac dysfunction
- •patients with low blood pressure
- •patients with ante-partum bleeding
Arms & Interventions
Norepinephrine 6 mcg
Mothers in this group will receive a bolus of Norepinephrine 6 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Norepinephrine 6 mcg
Norepinephrine 6 mcg
Mothers in this group will receive a bolus of Norepinephrine 6 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Bupivacaine Hydrochloride
Norepinephrine 6 mcg
Mothers in this group will receive a bolus of Norepinephrine 6 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Norepinephrine infusion
Norepinephrine 10 mcg
Mothers in this group will receive a bolus of Norepinephrine 10 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Norepinephrine 10 mcg
Norepinephrine 10 mcg
Mothers in this group will receive a bolus of Norepinephrine 10 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Bupivacaine Hydrochloride
Norepinephrine 10 mcg
Mothers in this group will receive a bolus of Norepinephrine 10 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
Intervention: Norepinephrine infusion
Outcomes
Primary Outcomes
Rate of successful management of maternal hypotension
Time Frame: 30 minutes after spinal anesthesia
number of patients with successful management of maternal hypotensive episode (defined as return of systolic blood pressure to be ≥ 80% of the baseline reading in the next reading 2 minutes after administration of norepinephrine bolus)
Secondary Outcomes
- Rate of successful management of severe maternal hypotension(30 minutes after spinal anesthesia)
- incidence of reactive hypertension(30 minutes after spinal anesthesia)
- systolic blood pressure(90 minutes after spinal anesthesia)
- heart rate(90 minutes after spinal block)
- Apgar score for evaluation of the activity of the fetus(10 minutes)
- Umbilical blood acidity(10 minutes after delivery)
- The frequency of vomiting(90 minutes after spinal anesthesia)