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Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia.
Anesth Analg. 2020 01; 130(1):187-193.A&A

Abstract

BACKGROUND

Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight.

METHODS

Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal-epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.

RESULTS

Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups.

CONCLUSIONS

Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively.

Authors+Show Affiliations

From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China. Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.Department of Anesthesia, Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China.From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Anesthesiology, Sidra Medicine, Doha, Qatar.From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30829668

Citation

Xiao, Fei, et al. "Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia." Anesthesia and Analgesia, vol. 130, no. 1, 2020, pp. 187-193.
Xiao F, Shen B, Xu WP, et al. Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia. Anesth Analg. 2020;130(1):187-193.
Xiao, F., Shen, B., Xu, W. P., Feng, Y., Ngan Kee, W. D., & Chen, X. Z. (2020). Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia. Anesthesia and Analgesia, 130(1), 187-193. https://doi.org/10.1213/ANE.0000000000004092
Xiao F, et al. Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia. Anesth Analg. 2020;130(1):187-193. PubMed PMID: 30829668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dose-Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia. AU - Xiao,Fei, AU - Shen,Bei, AU - Xu,Wen-Ping, AU - Feng,Ying, AU - Ngan Kee,Warwick D, AU - Chen,Xin-Zhong, PY - 2019/3/5/pubmed PY - 2020/4/21/medline PY - 2019/3/5/entrez SP - 187 EP - 193 JF - Anesthesia and analgesia JO - Anesth Analg VL - 130 IS - 1 N2 - BACKGROUND: Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight. METHODS: Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal-epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis. RESULTS: Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups. CONCLUSIONS: Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24-0.36) and 0.54 (95% CI, 0.46-0.76) µg/kg/min, respectively. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/30829668/Dose_Response_Study_of_4_Weight_Based_Phenylephrine_Infusion_Regimens_for_Preventing_Hypotension_During_Cesarean_Delivery_Under_Combined_Spinal_Epidural_Anesthesia_ L2 - https://doi.org/10.1213/ANE.0000000000004092 DB - PRIME DP - Unbound Medicine ER -