Oxytocin Requirements at Elective Cesarean Delivery: A Dose-Finding Study

2004 ◽  
Vol 104 (5, Part 1) ◽  
pp. 1005-1010 ◽  
Author(s):  
José C. A. Carvalho ◽  
Mrinalini Balki ◽  
John Kingdom ◽  
Rory Windrim
Keyword(s):  
Cesarean Delivery ◽  
Dose Finding ◽  
Elective Cesarean Delivery ◽  
Finding Study ◽  
Elective Cesarean ◽  
Dose Finding Study

scholarly journals Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: A dose-finding study based on the continual reassessment method

2020 ◽  
Author(s):  
Philippe Goffard ◽  
Yoann Vercruysse ◽  
Renaud Leloup ◽  
Jean-François Fils ◽  
Sylvie Chevret ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Dose Finding ◽  
Hyperbaric Bupivacaine ◽  
Continual Reassessment ◽  
Blinded Study ◽  
Finding Study ◽  
Elective Cesarean ◽  
Dose Finding Study ◽  
Double Blinded

Abstract BackgroundScheduled cesarean section is routinely performed under spinal anesthesia using hyperbaric bupivacaine. The current study was undertaken to determine the clinically relevant 95% effective dose of intrathecal 2% hyperbaric prilocaine co-administered with sufentanil for scheduled cesarean section, using continual reassessment method.MethodsWe conducted a dose-response, prospective, double-blinded study to determine the ED95 values of intrathecal hyperbaric prilocaine used with 2,5 mcg of sufentanil and 100 mcg of morphine for cesarean delivery. Each parturient enrolled in the study received an intrathecal dose of hyperbaric prilocaine determined by the CRM and the success or failure of the block was assessed as being the primary endpoint.ResultsThe doses given for each cohort varied from 35 to 50 mg of HP, according to the CRM, with a final ED95 lying between 45 and 50 mg of Prilocaine after completion of the 10 cohorts. Few side effects were reported and patients were globally satisfied.ConclusionsThe ED95 of intrathecal hyperbaric prilocaine with sufentanil 2.5 µg and morphine 100 µg for elective cesarean delivery was found to be between 45 and 50 mg. It may be an interesting alternative to other long-lasting local anesthetics in this context.Trial registrationThe study was registered on January 30, 2017 – retrospectively registered – and results posted at the public database clinicaltrials.gov (NCT03036384 – https://clinicaltrials.gov/ct2/show/NCT03036384).

scholarly journals Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: a dose-finding study based on the continual reassessment method

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
P. Goffard ◽  
Y. Vercruysse ◽  
R. Leloup ◽  
J-F Fils ◽  
S. Chevret ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Dose Finding ◽  
Hyperbaric Bupivacaine ◽  
Continual Reassessment Method ◽  
Continual Reassessment ◽  
Blinded Study ◽  
Finding Study ◽  
Elective Cesarean ◽  
Double Blinded

Abstract Background Scheduled cesarean section is routinely performed under spinal anesthesia using hyperbaric bupivacaine. The current study was undertaken to determine the clinically relevant 95% effective dose of intrathecal 2% hyperbaric prilocaine co-administered with sufentanil for scheduled cesarean section, using continual reassessment method. Methods We conducted a dose-response, prospective, double-blinded study to determine the ED95 values of intrathecal hyperbaric prilocaine used with 2,5 mcg of sufentanil and 100 mcg of morphine for cesarean delivery. Each parturient enrolled in the study received an intrathecal dose of hyperbaric prilocaine determined by the CRM and the success or failure of the block was assessed as being the primary endpoint. Results The doses given for each cohort varied from 35 to 50 mg of HP, according to the CRM, with a final ED95 lying between 45 and 50 mg of Prilocaine after completion of the 10 cohorts. Few side effects were reported and patients were globally satisfied. Conclusions The ED95 of intrathecal hyperbaric prilocaine with sufentanil 2.5 μg and morphine 100 μg for elective cesarean delivery was found to be between 45 and 50 mg. It may be an interesting alternative to other long-lasting local anesthetics in this context. Trial registration The study was registered on January 30, 2017 – retrospectively registered – and results posted at the public database clinicaltrials.gov (NCT03036384).

scholarly journals Optimum Dose of Spinal Ropivacaine with or Without Single Intravenous Bolus of S-Ketamine During Elective Cesarean Delivery: A Randomized, Sequential Dose-Finding Study

2021 ◽  
Author(s):  
Xiaoyu Zhang ◽  
Jianwei Wang ◽  
Xiao-Hu An ◽  
Yu-Chieh Chao ◽  
Yong Bian ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Depression Scale ◽  
Dose Finding ◽  
Optimum Dose ◽  
Sensory Level ◽  
Elective Cesarean Delivery ◽  
Clinical Trial Registration ◽  
Elective Cesarean ◽  
Vas Scores ◽  
Spinal Hypotension

Abstract Background Post-spinal hypotension has a high occurrence during cesarean delivery, and can lead to adverse maternal or fetal outcomes. The purpose of the study was to determine the optimal dose of spinal ropivacaine for cesarean section with or without intravenous single bolus of S-ketamine and to observe the incidences of hypotension of both methods. Methods Eighty women undergoing elective cesarean delivery were randomly allocated into Group ropivacaine or Group ropivacaine with intravenous S-ketamine. If the upper sensory level of the patient reached T6 and the visual analogue scale (VAS) scores continuously below 3 before delivery, the next patient had a 1/9th chance of receiving a lower dose or an 8/9th chance of receiving the same of previous dose. If the patient had VAS scores above 2 or needed an extra epidural rescue bolus before delivery, a higher dose was used for the next patient. The primary outcome was the successful use of spinal ropivacaine to maintain VAS of patients below 3 before delivery and the incidence of post-spinal hypotension of both groups. Secondary outcomes included the incidences of hypotension related symptoms and managements, upper sensory level of anesthesia, level of sedation, neonatal outcomes, Edinburgh postnatal depression scale scores on admission and discharging of hospital and post-operative analgesic effect. The 90% effective dose (ED90) and 95% confidence interval (95% CI) were estimated by isotonic regression. Results The estimated ED90 of ropivacaine was 11.8 mg (95% CI 11.7–12.7) with and 14.7 mg (95% CI 14.6–16.0) without intravenous S-ketamine using biased coin up-down sequential dose-finding method, and the incidences of hypotension and its related symptoms were significantly lower in S-ketamine group. Conclusions A spinal dose of ropivacaine 12 mg with single intravenous 0.15 mg/kg bolus dose of S-ketamine may significantly reduce the risk of hypotension and provide sedative status before delivery, thus the method could be cautiously used in parturients with high risks of hypotension or extreme nervousness. Clinical trial registration: http://www.chictr.org.cn (ChiCTR2000040375; 28 Nov 2020)

scholarly journals The ED50 and ED95 of Prophylactic Norepinephrine for Preventing Post-Spinal Hypotension During Cesarean Delivery Under Combined Spinal-Epidural Anesthesia: A Prospective Dose-Finding Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Wenping Xu ◽  
Dan Michael Drzymalski ◽  
Ling Ai ◽  
Hanqing Yao ◽  
Lin Liu ◽  
...  
Keyword(s):  
Effective Dose ◽  
Cesarean Delivery ◽  
Dose Finding ◽  
Induced Hypotension ◽  
Norepinephrine Infusion ◽  
Finding Study ◽  
Dose Finding Study ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural ◽  
Relationship Of

Background: Hypotension commonly occurs with spinal anesthesia during cesarean delivery. Norepinephrine is an alternative to phenylephrine which can be used to prevent or treat hypotension, with better maintained cardiac output and less bradycardia. However, an appropriate initial prophylactic infusion dose of norepinephrine remains unclear. The aim of this study was to describe the dose-response relationship of prophylactic norepinephrine infusion during cesarean delivery under combined spinal-epidural anesthesia.Methods: We performed a prospective, randomized, double-blinded dose-finding study. One hundred patients undergoing elective cesarean delivery were randomly assigned to receive an infusion of norepinephrine at 0, 0.025, 0.05, 0.075 or 0.1 μg/kg/min initiated immediately after intrathecal injection of 10 mg bupivacaine combined with 5 µg sufentanil. An effective dose was considered when there was no hypotension (systolic blood pressure < 90 mm Hg or < 80% of baseline) during the time period from injection of intrathecal local anesthetic to delivery of the neonate. The primary aim was to determine the dose-response relationship of norepinephrine to prevent spinal anesthesia-induced hypotension. The median effective dose (ED50) and 95% effective dose (ED95) for norepinephrine were calculated utilizing probit analysis.Results: The proportion of patients with hypotension was 80, 70, 40, 15 and 5% at norepinephrine doses of 0, 0.025, 0.05, 0.075 and 0.1 μg/kg/min, respectively. The ED50 and ED95 were 0.042 (95% CI, 0.025–0.053) µg/kg/min and 0.097 (95% CI, 0.081–0.134) µg/kg/min, respectively. There were no differences in the Apgar scores (p = 0.685) or umbilical arterial pH (p = 0.485) measurements of the newborns among the treatment groups.Conclusion: A norepinephrine infusion of 0.1 μg/kg/min as an initial starting dose was effective for the prevention of spinal-induced hypotension.

scholarly journals Determination of the ED95 of intrathecal hyperbaric prilocaine with sufentanil for scheduled cesarean delivery: A dose-finding study based on the continual reassessment method

2020 ◽  
Author(s):  
Philippe Goffard ◽  
Yoann Vercruysse ◽  
Renaud Leloup ◽  
Jean-François Fils ◽  
Sylvie Chevret ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Dose Finding ◽  
Hyperbaric Bupivacaine ◽  
Continual Reassessment Method ◽  
Continual Reassessment ◽  
Blinded Study ◽  
Finding Study ◽  
Elective Cesarean ◽  
Double Blinded

Abstract Background – Scheduled cesarean section is routinely performed under spinal anesthesia using hyperbaric bupivacaine. The current study was undertaken to determine the clinically relevant 95% effective dose of intrathecal 2% hyperbaric prilocaine co-administered with sufentanil for scheduled cesarean section, using continual reassessment method.Methods – We conducted a dose-response, prospective, double-blinded study to determine the ED95 values of intrathecal hyperbaric prilocaine used with 2,5 mcg of sufentanil and 100 mcg of morphine for cesarean delivery. Each parturient enrolled in the study received an intrathecal dose of hyperbaric prilocaine determined by the CRM and the success or failure of the block was assessed as being the primary endpoint.Results – The doses given for each cohort varied from 35 to 50 mg of HP, according to the CRM, with a final ED95 lying between 45 and 50 mg of Prilocaine after completion of the 10 cohorts. Few side effects were reported and patients were globally satisfied.Conclusions – The ED95 of intrathecal hyperbaric prilocaine with sufentanil 2.5 μg and morphine 100 μg for elective cesarean delivery was found to be between 45 and 50 mg. It may be an interesting alternative to other long-lasting local anesthetics in this context.Trial registration – The study was registered on January 30, 2017 – retrospectively registered – and results posted at the public database clinicaltrials.gov (NCT03036384 – https://clinicaltrials.gov/ct2/show/NCT03036384).

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