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Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial.
Arch Gynecol Obstet. 2020 Jun 25 [Online ahead of print]AG

Abstract

OBJECTIVE

To investigate the efficacy and safety of prophylactic infusion of norepinephrine (NE) versus normal saline in patients undergoing cesarean section.

METHODS

Patients (n = 97) were randomized to receive a bolus of NE (6 μg) immediately following spinal anesthesia with maintenance NE (0.05 μg/kg/min IV) or normal saline (n = 98). The primary endpoint was the incidence of postspinal anesthesia hypotension [systolic blood pressure (SBP) < 80% of baseline] at 1-20 min following spinal anesthesia. Secondary outcomes were the overall stability of SBP control versus baseline, inferior vena cava collapsibility index (IVC-CI), other adverse events (bradycardia, nausea, vomiting, and hypertension), and neonatal outcomes (blood gas values and Apgar scores).

RESULTS

The rates of postspinal anesthesia hypotension and severe postspinal anesthesia hypotension (SBP < 60% of the baseline) were significantly lower in the NE group (17.5% vs. 62.2%, p < 0.001; 7.2% vs. 17.4%, p = 0.031). In the NE group, SBP remained more stable and closer to baseline (p < 0.001), and IVC-CI values were lower 5 min after spinal anesthesia and 5 min after fetal delivery (p = 0.045; p < 0.001, respectively). Other adverse effects and neonatal outcomes were not different between the two groups.

CONCLUSION

Prophylactic NE infusion effectively lowers the incidence of postspinal anesthesia hypotension and does not increase other adverse events in patients or neonates.

Authors+Show Affiliations

Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China.Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China.Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China.Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China.Department of Obstetrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.Department of Obstetrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.Department of Obstetrics, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.Department of Anesthesiology, General Hospital of Ningxia Medical University, 804S Shengli Street, Yinchuan, 750004, Ningxia, China. xinlini6@nyfy.com.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32588134

Citation

Chen, Yi, et al. "Norepinephrine Prophylaxis for Postspinal Anesthesia Hypotension in Parturient Undergoing Cesarean Section: a Randomized, Controlled Trial." Archives of Gynecology and Obstetrics, 2020.
Chen Y, Guo L, Shi Y, et al. Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial. Arch Gynecol Obstet. 2020.
Chen, Y., Guo, L., Shi, Y., Ma, G., Xue, W., He, L., Ma, S., & Ni, X. (2020). Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial. Archives of Gynecology and Obstetrics. https://doi.org/10.1007/s00404-020-05663-7
Chen Y, et al. Norepinephrine Prophylaxis for Postspinal Anesthesia Hypotension in Parturient Undergoing Cesarean Section: a Randomized, Controlled Trial. Arch Gynecol Obstet. 2020 Jun 25; PubMed PMID: 32588134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Norepinephrine prophylaxis for postspinal anesthesia hypotension in parturient undergoing cesarean section: a randomized, controlled trial. AU - Chen,Yi, AU - Guo,Lei, AU - Shi,Yongqiang, AU - Ma,Gang, AU - Xue,Wei, AU - He,Ling, AU - Ma,Shuqin, AU - Ni,Xinli, Y1 - 2020/06/25/ PY - 2020/04/21/received PY - 2020/06/18/accepted PY - 2020/6/27/entrez KW - Cesarean section KW - Hypotension KW - Inferior vena cava collapsibility index KW - Norepinephrine KW - Spinal anesthesia JF - Archives of gynecology and obstetrics JO - Arch. Gynecol. Obstet. N2 - OBJECTIVE: To investigate the efficacy and safety of prophylactic infusion of norepinephrine (NE) versus normal saline in patients undergoing cesarean section. METHODS: Patients (n = 97) were randomized to receive a bolus of NE (6 μg) immediately following spinal anesthesia with maintenance NE (0.05 μg/kg/min IV) or normal saline (n = 98). The primary endpoint was the incidence of postspinal anesthesia hypotension [systolic blood pressure (SBP) < 80% of baseline] at 1-20 min following spinal anesthesia. Secondary outcomes were the overall stability of SBP control versus baseline, inferior vena cava collapsibility index (IVC-CI), other adverse events (bradycardia, nausea, vomiting, and hypertension), and neonatal outcomes (blood gas values and Apgar scores). RESULTS: The rates of postspinal anesthesia hypotension and severe postspinal anesthesia hypotension (SBP < 60% of the baseline) were significantly lower in the NE group (17.5% vs. 62.2%, p < 0.001; 7.2% vs. 17.4%, p = 0.031). In the NE group, SBP remained more stable and closer to baseline (p < 0.001), and IVC-CI values were lower 5 min after spinal anesthesia and 5 min after fetal delivery (p = 0.045; p < 0.001, respectively). Other adverse effects and neonatal outcomes were not different between the two groups. CONCLUSION: Prophylactic NE infusion effectively lowers the incidence of postspinal anesthesia hypotension and does not increase other adverse events in patients or neonates. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/32588134/Norepinephrine_prophylaxis_for_postspinal_anesthesia_hypotension_in_parturient_undergoing_cesarean_section:_a_randomized_controlled_trial_ L2 - https://dx.doi.org/10.1007/s00404-020-05663-7 DB - PRIME DP - Unbound Medicine ER -
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