Article Sidebar
Views pdf: 55
STUDY TO FIND 90% EFFECTIVE DOSE OF INTRAVENOUS PHENYLEPHRINE BOLUS TO PREVENT SPINAL - INDUCED HYPOTENSION DURING CESAREAN SECTION
Main Article Content
Abstract
Background: Spinal anesthesia is commonly used for cesarean section. The first-line vasopressor for prevetion or treatment of hypotention after spinal anesthesia for cesarean section is phenylephrine. Previous studies have not yet agreed on the optimal intravenous phenylephrine dose to this prevention. Objectives: To estimate the prophylactic intravenous phenylephrine dose to effectively prevent 90% of cases of hypotension in spinal anesthesia for cesarean section (ED90) and to record adverse events in surgery. Subjects and methods: A prospective, dose-finding study using a “k-in-a-row” design. The study included 60 ASA II women with singleton, healthy term pregnancies who were Indicated for non-emergency cesarean section and spinal anesthesia. Immediately after spinal anesthesia, the first woman received a dose of intravenous phenylephrine 0.7 μg/kg to prevent hypotension. The next woman received an increase of 0.1 μg/kg, a decrease of 0.1 μg/kg, or the same dose, depending on the response of the previous patient. Hypotension after spinal anesthesia occurred when systolic blood pressure <80% of the baseline value. Results: The estimated prophylactic intravenous phenylephrine dose that effectively prevented 90% of cases of hypotension during spinal anesthesia for elective cesarean section (ED90) was 1.643 μg/kg (95% CI, 1.56–1.69 μg/kg) by isotonic regression and 1.61 μg/kg (90% CI, 1.265–1.83 μg/kg) by centered isotonic regression. Conclusion: The ED90 of phenylephrine given as a single intravenous dose to prevent spinal-induced hypotension during cesarean section is 1,61 μg/kg
Article Details
Keywords
spinal anesthesia, hypotension, ED90, phenylephrine, cesarean section
References
2. Kinsella SM, et al. (2018), “International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia”, Anaesthesia, 73, pp: 3-6.
3. Lee HM, Kim SH, Hwang BY, et al. (2016), “The effects of prophylactic bolus phenylephrine on hypotension during low-dose spinal anesthesia for cesarean section”, Int J Obstet Anesth, 25, pp: 17-22.
4. Lê Văn Tâm, Dương Thị Ngọc Anh, Trần Xuân Thịnh, Nguyễn Văn Minh (2023), “Đánh giá hiệu quả dự phòng tụt huyết áp của hai liều phenylephrin tiêm tĩnh mạch sau gây tê tủy sống để phẫu thuật lấy thai”, Tập chí Y Dược-Trường Đại học Y Dược Huế-số 1, tập 13, tr: 14-21.
5. Tanaka M, Balki M, Parkes RK, Carvalho J C A (2009), “ED95 of phenylephrine to prevent spinal-induced hypotension and/or nausea at elective cesarean delivery”, Int J Obstet Anesth, 18(2), pp: 125-30.
6. Zhang X-M, Qian J, Liu L, Shen Y-P, Xiao F (2024), “Effect of crystalloid solution co-loading infusion rate on the dose requirements of prophylactic phenylephrine for preventing hypotension following combined spinal-epidural anesthesia for cesarean delivery”, BMC Pregnancy Childbirth, 24(1), pp:743.
7. Pace NL, Stat. M, Stylianou MP (2007), “Advances in and Limitations of Up-and-down Methodology”, Anesthesiology, 107, pp: 144–52.
8. Oron Ap and Flournoy N (2024), “Up-and-Down: The Most Popular, Most Reliable, and Most Overlooked Dose-Finding Design”, The New England Journal of Statistics in Data Science Volume 0, pp: 1–12.
9. Oron AP, Souter MJ, Flournoy N (2022), “Understanding Research Methods: Up-and-down Designs for Dose-finding”, Anesthesiology, 137(2), pp: 137-150.
10. Guo L, Xu X, Qin R, et al. (2023), “Prophylactic Norepinephrine and Phenylephrine Boluses to Prevent Postspinal Anesthesia Hypotension During Cesarean Section: A Randomized Sequential Allocation Dose-Finding Study”, Drug Des Devel Ther, 17, pp: 1547-1555.