Perioperative Infusion, Ephedrine, Noradrenaline, Cesarean Delivery, Spinal Anesthesia
Conditions
Brief summary
This study aimed to compare the effects of prophylactic ephedrine and nor-epinephrine infusion on maternal hemodynamics and neonatal outcomes following spinal anesthesia in cesarean deliveries.
Detailed description
Neuraxial anesthesia for cesarean delivery (CD) has significantly reduced maternal mortality by avoiding Manipulation of the airway, the mother being awake, and promoting early bonding of mother and child, adequate Postoperative analgesia, and quicker maternal recovery. Systemic vascular resistance decreases as a result of a reduction in sympathetic tone of the arterial circulation, leading to peripheral arterial vasodilation, the extent of which depends on the number of spinal segments involved. Other theories are proposed to explain hypotension during spinal anesthesia, among them: 1)direct depressive circulatory effect of local anesthetics, 2) relative adrenal insufficiency, 3) skeletal muscle paralysis, 4) ascending medullary vasomotor block, and 5) concurrent mechanical respiratory insufficiency. Loss of sympathetic input to the heart, leaving vagal parasympathetic innervations unopposed, and a decrease in cardiac preload are the main reasons for bradycardia during spinal anesthesia.
Interventions
DRUGEphedrine
The parturient will receive ephedrine infusion immediately before intrathecal injection till delivery of the baby at a dose of 4mg /min.
DRUGNoradrenaline
The parturient will receive noradrenaline infusion immediately before intrathecal injection till delivery of the baby at a dose of 4 microgram/minute.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age more than 21 years. * American Society of Anesthesiologists Physical Status II and III. * Full-term singleton pregnant women scheduled for elective cesarean section under spinal anesthesia.
Exclusion criteria
* Morbid obesity \[body mass index (BMI)\>40\]. * Diabetes Mellitus. * Severe cardiovascular disease. * Hypertensive disorders of pregnancy. * Chronic kidney disease. * Non-assuring fetal status. * Peripartum bleeding.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maternal systolic blood pressure | 10 minutes after induction of spinal anesthesia | Maternal systolic blood pressure was recorded 10 minutes after induction of spinal anesthesia. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Heart rate | Intraoperatively | Intraoperative heart rate was recorded after spinal anesthesia induction. |
| Number of needed rescue boluses of vasopressors | After induction of spinal anesthesia (Up to 2 hours) | Number of needed rescue boluses of vasopressors to keep hemodynamic stability after spinal anesthesia induction. |
| Incidence of adverse events | 2 hours after induction of spinal anesthesia | Incidence of adverse events such as nausea and vomiting were recorded. |
| APGAR score | 5 minutes after delivery | APGAR score was recorded at 1 and 5 minutes after delivery. |
Countries
Egypt
Outcome results
None listed