Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial
Sarah M Amin, Ahmed Hasanin, Nashwa Talaat Ghanem, Maha Mostafa, Nashwa Elzayat, Mona Elsherbiny, Yaser Abdelwahab Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Hasanin, Department of Anesthesia and Critical Care Medicine, Cairo University,...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2024-01-01
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| Series: | International Journal of General Medicine |
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| Online Access: | https://www.dovepress.com/comparison-of-two-norepinephrine-rescue-bolus-doses-for-management-of--peer-reviewed-fulltext-article-IJGM |
| _version_ | 1797349547822809088 |
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| author | Amin SM Hasanin A Ghanem NT Mostafa M Elzayat N Elsherbiny M Abdelwahab Y |
| author_facet | Amin SM Hasanin A Ghanem NT Mostafa M Elzayat N Elsherbiny M Abdelwahab Y |
| author_sort | Amin SM |
| collection | DOAJ |
| description | Sarah M Amin, Ahmed Hasanin, Nashwa Talaat Ghanem, Maha Mostafa, Nashwa Elzayat, Mona Elsherbiny, Yaser Abdelwahab Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Hasanin, Department of Anesthesia and Critical Care Medicine, Cairo University, Faculty of Medicine, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt, Fax +20224168736, Email ahmedmohamedhasanin@gmail.comBackground: Post-spinal hypotension is associated with maternal and neonatal complications; therefore, prompt control maternal blood pressure is necessary. In this study, we aimed to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of severe maternal hypotension during elective Cesarean delivery.Methods: We included full-term pregnant women scheduled for Cesarean delivery under spinal anesthesia. Patients were randomized to receive either 5-mcg norepinephrine (n=79) or 10-mcg norepinephrine (n=79) for treatment of severe postspinal hypotension (systolic blood pressure ≤ 60% of baseline reading). The management of the hypotensive episode was considered successful if systolic blood pressure was > 80% of the baseline within 2 mins of the bolus. The primary outcome was the incidence of successful management of severe post-spinal hypotension. Secondary outcomes included the incidence of reactive bradycardia, reactive hypertension, umbilical blood gases, and neonatal Apgar score at 5-min post-delivery.Results: We included 73 patients in the 5-mcg group and 76 patients in the 10-mcg group into the final analysis. The incidence of successful management of severe hypotensive episodes was comparable between the two groups (43/73 [59%] and 46/76 [60%] in the 5-and 10-mcg group, respectively, P=0.917). The incidence of reactive hypertension, bradycardia, and neonatal outcomes were comparable between the two groups.Conclusion: In mothers undergoing Cesarean delivery under spinal anesthesia, 10-mcg norepinephrine bolus was not superior to the 5-mcg bolus in the management of severe hypotension. Furthermore, the incidence of reactive bradycardia and hypertension was comparable in the two doses.Clinical Trial Registration: NCT05290740, URL: https://clinicaltrials.gov/ct2/show/NCT05290740.Keywords: cesarean delivery, spinal anesthesia, severe hypotension, norepinephrine |
| first_indexed | 2024-03-08T12:31:50Z |
| format | Article |
| id | doaj.art-0119a39989d442e2945c7e7b0ed9e741 |
| institution | Directory Open Access Journal |
| issn | 1178-7074 |
| language | English |
| last_indexed | 2024-03-08T12:31:50Z |
| publishDate | 2024-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | International Journal of General Medicine |
| spelling | doaj.art-0119a39989d442e2945c7e7b0ed9e7412024-01-21T18:27:54ZengDove Medical PressInternational Journal of General Medicine1178-70742024-01-01Volume 1715316089822Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled TrialAmin SMHasanin AGhanem NTMostafa MElzayat NElsherbiny MAbdelwahab YSarah M Amin, Ahmed Hasanin, Nashwa Talaat Ghanem, Maha Mostafa, Nashwa Elzayat, Mona Elsherbiny, Yaser Abdelwahab Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, EgyptCorrespondence: Ahmed Hasanin, Department of Anesthesia and Critical Care Medicine, Cairo University, Faculty of Medicine, 01 Elsarayah Street, Elmanyal, Cairo, 11559, Egypt, Fax +20224168736, Email ahmedmohamedhasanin@gmail.comBackground: Post-spinal hypotension is associated with maternal and neonatal complications; therefore, prompt control maternal blood pressure is necessary. In this study, we aimed to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of severe maternal hypotension during elective Cesarean delivery.Methods: We included full-term pregnant women scheduled for Cesarean delivery under spinal anesthesia. Patients were randomized to receive either 5-mcg norepinephrine (n=79) or 10-mcg norepinephrine (n=79) for treatment of severe postspinal hypotension (systolic blood pressure ≤ 60% of baseline reading). The management of the hypotensive episode was considered successful if systolic blood pressure was > 80% of the baseline within 2 mins of the bolus. The primary outcome was the incidence of successful management of severe post-spinal hypotension. Secondary outcomes included the incidence of reactive bradycardia, reactive hypertension, umbilical blood gases, and neonatal Apgar score at 5-min post-delivery.Results: We included 73 patients in the 5-mcg group and 76 patients in the 10-mcg group into the final analysis. The incidence of successful management of severe hypotensive episodes was comparable between the two groups (43/73 [59%] and 46/76 [60%] in the 5-and 10-mcg group, respectively, P=0.917). The incidence of reactive hypertension, bradycardia, and neonatal outcomes were comparable between the two groups.Conclusion: In mothers undergoing Cesarean delivery under spinal anesthesia, 10-mcg norepinephrine bolus was not superior to the 5-mcg bolus in the management of severe hypotension. Furthermore, the incidence of reactive bradycardia and hypertension was comparable in the two doses.Clinical Trial Registration: NCT05290740, URL: https://clinicaltrials.gov/ct2/show/NCT05290740.Keywords: cesarean delivery, spinal anesthesia, severe hypotension, norepinephrinehttps://www.dovepress.com/comparison-of-two-norepinephrine-rescue-bolus-doses-for-management-of--peer-reviewed-fulltext-article-IJGMcesarean deliveryspinal anesthesiasevere hypotensionnorepinephrine |
| spellingShingle | Amin SM Hasanin A Ghanem NT Mostafa M Elzayat N Elsherbiny M Abdelwahab Y Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial International Journal of General Medicine cesarean delivery spinal anesthesia severe hypotension norepinephrine |
| title | Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial |
| title_full | Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial |
| title_fullStr | Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial |
| title_full_unstemmed | Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial |
| title_short | Comparison of Two Norepinephrine Rescue Bolus Doses for Management of Severe Post-Spinal Hypotension During Elective Caesarean Delivery: A Randomized, Controlled Trial |
| title_sort | comparison of two norepinephrine rescue bolus doses for management of severe post spinal hypotension during elective caesarean delivery a randomized controlled trial |
| topic | cesarean delivery spinal anesthesia severe hypotension norepinephrine |
| url | https://www.dovepress.com/comparison-of-two-norepinephrine-rescue-bolus-doses-for-management-of--peer-reviewed-fulltext-article-IJGM |
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