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Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients with Severe Preeclampsia during Cesarean Delivery: A Pilot Study.
Drug Des Devel Ther. 2021; 15:3765-3772.DD

Abstract

PURPOSE

Treatment of spinal anesthesia-induced hypotension in patients with severe preeclampsia assumes special concern as hypotension may further reduce placental perfusion. Phenylephrine is still the first-line vasopressor for treating spinal anesthesia-induced hypotension. However, the optimal dose of phenylephrine used as intravenous (IV) boluses in patients with severe preeclampsia has not been clearly determined. We aim to calculate the 90% effective dose (ED90) of phenylephrine as IV boluses for treating spinal anesthesia-induced hypotension in patients with severe preeclampsia undergoing cesarean delivery.

PATIENTS AND METHODS

Forty patients with severe preeclampsia were enrolled in this prospective sequential allocation dose-finding trial. Using the biased coin up-and-down (BCUD) method, all patients in our study received an IV bolus phenylephrine of either 40, 50, 60, 70, or 80 µg when the mean arterial pressure (MAP) decreased to less than 80% of the baseline level and the ED90 was determined. The primary outcome was the success of the assigned phenylephrine bolus to maintain the MAP at or above 80% of baseline value between the induction of spinal anesthesia and delivery of the fetus. Secondary outcomes included hypertension, nausea, vomiting, bradycardia, upper sensory level of anesthesia, umbilical blood gases, and Apgar score. Estimating of the ED90 with 95% confidence interval (CI) was achieved by isotonic regression method.

RESULTS

The ED90 of phenylephrine was estimated as 62.00 µg (95% CI=50.00-67.40 µg) using the isotonic regression method. No patients enrolled in our study experienced bradycardia and those patients who developed hypertension were all observed at the dose level 70 µg.

CONCLUSION

For clinical practice, we recommend that phenylephrine 60 µg may be both effective and safe for treatment of spinal anesthesia-induced hypotension in severe preeclampsia during cesarean delivery.

Authors+Show Affiliations

Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.Department of Anesthesiology, Haining Maternal and Child Health Hospital, Jiaxing, People's Republic of China.Department of Anesthesiology, Haining Maternal and Child Health Hospital, Jiaxing, People's Republic of China.Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.Department of Anesthesiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

34522082

Citation

Liu, Jin-Ping, et al. "Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients With Severe Preeclampsia During Cesarean Delivery: a Pilot Study." Drug Design, Development and Therapy, vol. 15, 2021, pp. 3765-3772.
Liu JP, Pan ZB, Zhu M, et al. Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients with Severe Preeclampsia during Cesarean Delivery: A Pilot Study. Drug Des Devel Ther. 2021;15:3765-3772.
Liu, J. P., Pan, Z. B., Zhu, M., Zhu, G. W., Song, D. B., Chen, X. Z., & Qian, X. W. (2021). Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients with Severe Preeclampsia during Cesarean Delivery: A Pilot Study. Drug Design, Development and Therapy, 15, 3765-3772. https://doi.org/10.2147/DDDT.S323715
Liu JP, et al. Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients With Severe Preeclampsia During Cesarean Delivery: a Pilot Study. Drug Des Devel Ther. 2021;15:3765-3772. PubMed PMID: 34522082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Determination of the 90% Effective Dose of Phenylephrine Boluses to Treat Spinal Anesthesia-Induced Hypotension in Patients with Severe Preeclampsia during Cesarean Delivery: A Pilot Study. AU - Liu,Jin-Ping, AU - Pan,Zheng-Bin, AU - Zhu,Miao, AU - Zhu,Guo-Wei, AU - Song,Da-Bing, AU - Chen,Xin-Zhong, AU - Qian,Xiao-Wei, Y1 - 2021/09/07/ PY - 2021/06/07/received PY - 2021/08/14/accepted PY - 2021/9/15/entrez PY - 2021/9/16/pubmed PY - 2022/1/21/medline KW - ED90 KW - biased coin up-and-down method KW - hypotension KW - phenylephrine KW - preeclampsia SP - 3765 EP - 3772 JF - Drug design, development and therapy JO - Drug Des Devel Ther VL - 15 N2 - PURPOSE: Treatment of spinal anesthesia-induced hypotension in patients with severe preeclampsia assumes special concern as hypotension may further reduce placental perfusion. Phenylephrine is still the first-line vasopressor for treating spinal anesthesia-induced hypotension. However, the optimal dose of phenylephrine used as intravenous (IV) boluses in patients with severe preeclampsia has not been clearly determined. We aim to calculate the 90% effective dose (ED90) of phenylephrine as IV boluses for treating spinal anesthesia-induced hypotension in patients with severe preeclampsia undergoing cesarean delivery. PATIENTS AND METHODS: Forty patients with severe preeclampsia were enrolled in this prospective sequential allocation dose-finding trial. Using the biased coin up-and-down (BCUD) method, all patients in our study received an IV bolus phenylephrine of either 40, 50, 60, 70, or 80 µg when the mean arterial pressure (MAP) decreased to less than 80% of the baseline level and the ED90 was determined. The primary outcome was the success of the assigned phenylephrine bolus to maintain the MAP at or above 80% of baseline value between the induction of spinal anesthesia and delivery of the fetus. Secondary outcomes included hypertension, nausea, vomiting, bradycardia, upper sensory level of anesthesia, umbilical blood gases, and Apgar score. Estimating of the ED90 with 95% confidence interval (CI) was achieved by isotonic regression method. RESULTS: The ED90 of phenylephrine was estimated as 62.00 µg (95% CI=50.00-67.40 µg) using the isotonic regression method. No patients enrolled in our study experienced bradycardia and those patients who developed hypertension were all observed at the dose level 70 µg. CONCLUSION: For clinical practice, we recommend that phenylephrine 60 µg may be both effective and safe for treatment of spinal anesthesia-induced hypotension in severe preeclampsia during cesarean delivery. SN - 1177-8881 UR - https://www.unboundmedicine.com/medline/citation/34522082/Determination_of_the_90_Effective_Dose_of_Phenylephrine_Boluses_to_Treat_Spinal_Anesthesia_Induced_Hypotension_in_Patients_with_Severe_Preeclampsia_during_Cesarean_Delivery:_A_Pilot_Study_ L2 - https://dx.doi.org/10.2147/DDDT.S323715 DB - PRIME DP - Unbound Medicine ER -