Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used admin...Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China.Thus,in this randomized,double-blinded study,we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension.Methods:In a tertiary women’s hospital in Nanjing,China,102 women were allocated with computer derived randomized number to receive prophylactic 8 mg norepinephrine(group N;n=52)or 100 mg phenylephrine(group P;n=50)immediately post-spinal anesthesia,followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80%of the baseline.Our primary outcome was standardized maternal cardiac output(CO)reading from spinal anesthesia until delivery analyzed by a two-step method.Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes.Maternal side effects and neonatal outcomes were collected as well.Results:Compared to group P,women in groupNhad a higherCO(standardizedCO5.8±0.9 vs.5.3±1.0 L/min,t=2.37,P=0.02)and stroke volume(SV,standardized SV 73.6±17.2 vs.60.0±13.3 mL,t=4.52,P<0.001),and a lower total peripheral resistance(875±174 vs.996±182 dyne·s/cm5,t=3.44,P<0.001).Furthermore,the incidence of bradycardia was lower in group N than in group P(2%vs.14%,P=0.023),along with an overall higher standardized heart rate(78.8±11.6 vs.75.0±7.3 beats/min,P=0.049).Other hemodynamics,as well as maternal side effects and neonatal outcomes,were similar in two groups(P>0.05).Conclusions:Compared to equivalent phenylephrine,intermittent bolus norepinephrine provides a greater CO for management of maternal hypotension during elective cesarean section with spinal anesthesia;however,no obvious maternal or neonatal clinical advantages were observed for norepinephrine.展开更多
文摘Background:In recent years,norepinephrine has attracted increasing attention for the management of maternal hypotension during elective cesarean section with spinal anesthesia.Intermittent bolus is a widely used administration paradigm for vasopressors in obstetric anesthesia in China.Thus,in this randomized,double-blinded study,we compared the efficacy and safety of equivalent bolus norepinephrine and phenylephrine for rescuing maternal post-spinal hypotension.Methods:In a tertiary women’s hospital in Nanjing,China,102 women were allocated with computer derived randomized number to receive prophylactic 8 mg norepinephrine(group N;n=52)or 100 mg phenylephrine(group P;n=50)immediately post-spinal anesthesia,followed by an extra bolus of the same dosage until delivery whenever maternal systolic blood pressure became lower than 80%of the baseline.Our primary outcome was standardized maternal cardiac output(CO)reading from spinal anesthesia until delivery analyzed by a two-step method.Other hemodynamic parameters related to vasopressor efficacy and safety were considered as secondary outcomes.Maternal side effects and neonatal outcomes were collected as well.Results:Compared to group P,women in groupNhad a higherCO(standardizedCO5.8±0.9 vs.5.3±1.0 L/min,t=2.37,P=0.02)and stroke volume(SV,standardized SV 73.6±17.2 vs.60.0±13.3 mL,t=4.52,P<0.001),and a lower total peripheral resistance(875±174 vs.996±182 dyne·s/cm5,t=3.44,P<0.001).Furthermore,the incidence of bradycardia was lower in group N than in group P(2%vs.14%,P=0.023),along with an overall higher standardized heart rate(78.8±11.6 vs.75.0±7.3 beats/min,P=0.049).Other hemodynamics,as well as maternal side effects and neonatal outcomes,were similar in two groups(P>0.05).Conclusions:Compared to equivalent phenylephrine,intermittent bolus norepinephrine provides a greater CO for management of maternal hypotension during elective cesarean section with spinal anesthesia;however,no obvious maternal or neonatal clinical advantages were observed for norepinephrine.
