scholarly journals Norepinephrine versus phenylephrine infusion for preventing postspinal hypotension during cesarean section for twin pregnancy: a double-blinded randomized controlled clinical trial

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Zijun Chen ◽  
Jieshu Zhou ◽  
Li Wan ◽  
Han Huang

Abstract Background Compared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and a resultant decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins. Methods Informed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors. Results There was no significant difference observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI − 0.1 to 9.0; P = .0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP was 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors. Conclusion Infusion of norepinephrine was not associated with less overall decrease in heart rate during cesarean section for twins, compared with phenylephrine. Trial registration Chinese Clinical Trial Registry (ChiCTR1900021281).

2021 ◽  
Author(s):  
Zijun Chen ◽  
Jieshu Zhou ◽  
Li Wan ◽  
Han Huang

Abstract BackgroundCompared with singleton pregnancy, twin gestation is featured by a greater increase in cardiac output. Therefore, norepinephrine might be more suitable than phenylephrine for maintaining blood pressure during cesarean section for twins, as phenylephrine causes reflex bradycardia and resultant a decrease in cardiac output. This study was to determine whether norepinephrine was superior to phenylephrine in maintaining maternal hemodynamics during cesarean section for twins.MethodsInformed consent was obtained from all the patients before enrollment. In this double-blinded, randomized clinical trial, 100 parturients with twin gestation undergoing cesarean section with spinal anesthesia were randomized to receive prophylactic norepinephrine (3.2 μg/min) or phenylephrine infusion (40 μg/min). The primary outcome was the change of heart rate and blood pressure during the study period. The secondary outcomes were to compare maternal complications, neonatal outcomes, Apgar scores and umbilical blood acid-base status between the two vasopressors.Results: There was no significant difference was observed for the change of heart rate between two vasopressors. The mean standardized area under the curve of heart rate was 78 ± 12 with norepinephrine vs. 74 ± 11 beats/min with phenylephrine (mean difference 4.4, 95%CI -0.1 to 9.0; P =.0567). The mean standardized area under the curve of systolic blood pressure (SBP) was significantly lower in parturients with norepinephrine, as the mean of differences in standardized AUC of SBP is 6 mmHg, with a 95% CI from 2 to 9 mmHg (P = .0013). However, requirements of physician interventions for correcting maternal hemodynamical abnormalities (temporary cessation of vasopressor infusion for reactive hypertension, rescuing vasopressor bolus for hypotension and atropine for heart rate less < 50 beats/min) and neonatal outcomes were also not significantly different between two vasopressors.Conclusion: Infusion of norepinephrine was not associated with less decrease in heart rate during cesarean section for twins, compared with phenylephrine. Clinical trial number: Chinese Clinical Trial Registry (ChiCTR1900021281) Clinical trial registry URL: http://www.chictr.org.cn/showproj.aspx?proj=35234


2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Mahshid Nikooseresht ◽  
Mohammad Ali Seifrabiei ◽  
Pouran Hajian ◽  
Shadab Khamooshi

Background: Phenylephrine is used to prevent and treat hypotension during spinal anesthesia for cesarean delivery. Objectives: The present study aims to investigate the effects of different regimens of phenylephrine on blood pressure of candidates for the cesarean section. Methods: In this double-blind, randomized clinical trial, a total of 120 candidates of elective cesarean delivery under spinal anesthesia was randomly categorized into three groups. Groups 1, 2, and 3 received bolus and prophylactic saline (control group), prophylactic bolus phenylephrine (100 µg), and prophylactic phenylephrine infusion (50 µg/min), respectively. The incidence of hypotension, maternal hemodynamics, hypertension, rescue phenylephrine dose, nausea, and vomit were compared between the groups. Results: In all the three groups, the incidence of nausea and vomit, bradycardia, hypertension, and neonatal Apgar score were not statistically different (P > 0.05). However, the adjuvant phenylephrine dose requirement was remarkably different. Moreover, the mean systolic blood pressure differed significantly in the second and 7th minutes after the spinal block (P < 0.05). 35% in the first group, 15% in the second group, and 2.5% in the third group had hypotension (P = 0.001). Apart from the first measurement after spinal anesthesia, the mean heart rate showed no significant difference between the groups. Conclusions: The use of prophylactic phenylephrine infusion is recommended to control the optimal blood pressure in parturients undergoing cesarean section after spinal anesthesia.


2021 ◽  
Vol 17 ◽  
Author(s):  
Jamshid Eslami ◽  
Neda Hatami ◽  
Aazadeh Amiri ◽  
Marzieh Akbarzadeh

Background: : Changes in physiological parameters in pregnant women are important factors in mothers who are candidates for cesarean section. Objective:: The aim of present study was to investigate the effect of operating room and cesarean section orientation on the physiological parameters (BP, heart rate, respiration) of pregnant women undergoing cesarean section. Materials and Methods:: This clinical trial study was performed on 80 pregnant women referring to cesarean section in hospitals affiliated to Shiraz University of Medical Sciences in 2019. The samples were randomly divided into two control (n = 40) and intervention groups (n = 40). The intervention group participated in 4 sessions of training classes. The control group used routine hospital trainings. The parameters were measured before and after the intervention in two groups. Data were analyzed using SPSS software (version 21), independent t-test and analysis of covariance. Results: The mean of post-training blood pressure in the intervention group 82.78(7.86) and in the control group 84.08 (7.44) was not statistically significant (p < .487). After intervention, the mean of heart rate in the intervention group 82.15 (8.10) and in the control group 83.43 (8.54) was statistically significant (p <0.0001). After intervention, the mean of respiratory rate in the intervention group was 94.28 (0.96) and in the control group was 75.96 (1.08) (P <0.0001). Conclusions: Although the patient's operating room and cesarean section orientation did not affect mothers' mean blood pressure; it reduced the mean of their heart rate and respiratory rate. It is important for medical staff to play an important role in identifying important strategies in managing the anxiety of pregnant women in order to improve their physiological indicators.


2015 ◽  
Vol 122 (4) ◽  
pp. 736-745 ◽  
Author(s):  
Warwick D. Ngan Kee ◽  
Shara W. Y. Lee ◽  
Floria F. Ng ◽  
Perpetua E. Tan ◽  
Kim S. Khaw

Abstract Background: During spinal anesthesia for cesarean delivery, phenylephrine can cause reflexive decreases in maternal heart rate and cardiac output. Norepinephrine has weak β-adrenergic receptor agonist activity in addition to potent α-adrenergic receptor activity and therefore may be suitable for maintaining blood pressure with less negative effects on heart rate and cardiac output compared with phenylephrine. Methods: In a randomized, double-blinded study, 104 healthy patients having cesarean delivery under spinal anesthesia were randomized to have systolic blood pressure maintained with a computer-controlled infusion of norepinephrine 5 μg/ml or phenylephrine 100 μg/ml. The primary outcome compared was cardiac output. Blood pressure heart rate and neonatal outcome were also compared. Results: Normalized cardiac output 5 min after induction was greater in the norepinephrine group versus the phenylephrine group (median 102.7% [interquartile range, 94.3 to 116.7%] versus 93.8% [85.0 to 103.1%], P = 0.004, median difference 9.8%, 95% CI of difference between medians 2.8 to 16.1%). From induction until uterine incision, for norepinephrine versus phenylephrine, systolic blood pressure and stroke volume were similar, heart rate and cardiac output were greater, systemic vascular resistance was lower, and the incidence of bradycardia was smaller. Neonatal outcome was similar between groups. Conclusions: When given by computer-controlled infusion during spinal anesthesia for cesarean delivery, norepinephrine was effective for maintaining blood pressure and was associated with greater heart rate and cardiac output compared with phenylephrine. Further work would be of interest to confirm the safety and efficacy of norepinephrine as a vasopressor in obstetric patients.


2020 ◽  
Author(s):  
Zahra Akbarian Rad ◽  
Parvin Aziznejadroshan ◽  
Adeleh Saebi Amiri ◽  
Hemmat Gholinia Ahangar ◽  
Zahra Valizadehchari

Abstract Background: Non-pharmacologic pain relief in preterm infant is an important measure. Familiar odors for neonates have soothing effects in some researches. The aim of this study was to compare the effect of maternal breast milk odor (MBMO) with that of another mother’s breast milk odor (BMO) on the behavioral responses to pain caused by hepatitis B (HB) vaccine injection in preterm infants.Methods: This single-blind randomized clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran from February 2019 to March 2020. Ninety preterm infants who must to be receive the HB vaccine, were randomly assigned into three groups of MBMO (A), another mother’s BMO (B) and control with distilled water(C). Oxygen saturation(SaO2), blood pressure(BP) and heart rate(HR) were recorded by electronic monitoring and premature infant pain profile (PIPP) were determined through video recording in tree groups during intervention. The chi-square, ANOVA and ANCOVA were used for analyzing data, and P<0.05 was considered significant.Results: No significant differences were seen between tree groups in mean± SD of HR, BP, Sao2 before intervention, (P>0.05). After intervention, the mean heart rate in group A, B and C was 146. 6±14.3, 153.70±17.5 and 155.70±17.7 respectively, (P=0.01). There was no significant difference between groups in the mean of SaO2, systolic and diastolic blood pressure after intervention (P>0.05). The mean PIPP score in groups A, B and C was 6.6±1.3, 10 ±2 and 11.4±1.9 respectively, (P<0.001).Conclusions: Stimulation with MBMO is effective in reducing the pain of preterm infants, so it can be used in less invasive procedures such as needling.Trial registration: IRCT, IRCT20190220042771N1. Registered 18 May 2019- Retrospectively registered, https://en.irct.ir/trial/37646


2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Amir Shafa ◽  
Hastisadat Aledavud ◽  
Hamidreza Shetabi ◽  
Sedige Shahhosseini

Background: Due to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy. Methods: This double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes. Results: Our data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients. Conclusions: The use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.


2020 ◽  
Vol 148 (3-4) ◽  
pp. 173-179
Author(s):  
Aleksandra Vukotic ◽  
David Green ◽  
Jasna Jevdjic ◽  
Milovan Vukotic ◽  
Nina Petrovic ◽  
...  

Introduction/Objective. Spinal anesthesia (SA) for cesarean section may lead to significant changes in hemodynamic parameters, especially hypotension. The aim of this study was to determine and compare the efficacy and safety of preemptive infusion protocols of the two most commonly used vasopressors, ephedrine (Group E, n = 29) and phenylephrine (Group P, n = 31) not only on prevention of hypotension but also to determine their effect on hemodynamic parameters, such as stroke volume (SV) and cardiac output (CO) using a continuous non-invasive hemodynamic monitor. Methods. The infusion of ephedrine was administered at the rate of 5 mg/min. immediately after SA. Phenylephrine was administered at an infusion rate of 25 ?g/min for two minutes prior to SA. Results. In Group E, mean systolic blood pressure (SBP) and heart rate (HR) were similar to baseline. CO was higher (p < 0.001), while systemic vascular resistance (SVR) was lower than baseline (p < 0.001). In Group P, mean SBP and diastolic blood pressure (DBP) were lower than baseline, respectively (p = 0.006, p < 0.001). SBP, DBP, CO, SV, SVR, and HR were significantly different between the E and P groups (p < 0.001). Conclusion. E and P vasopressors are both effective in the prevention of hypotension during SA.


2020 ◽  
Author(s):  
Adeleh Saebi Amiri ◽  
parvin aziznejadroshan ◽  
Zahra Akbarian Rad ◽  
Hemmat gholinia ahangar ◽  
Zahra Valizadehchari

Abstract Background: Pain control in preterm infants is especially important if the necessary measures are not taken in this regard, the evolutionary process of the brain will be disrupted, and the unrelieved pain can have lifelong consequences. The aim of this study was to compare the effect of maternal breast milk odor (MBMO) with that of another mother’s breast milk odor (BMO) on the behavioral responses to pain caused by hepatitis B vaccine (HBV) injection in preterm infants.Methods: This single-blind randomized clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran from February 2019 to March 2020. Totally, 90 preterm infants who were to receive the HBV for the first time were randomly selected by random sampling. The neonates were randomly assigned into three groups of (A) MBMO (B) another mother’s BMO and (C) control (distilled water).The data were collected using a questionnaire of demographic characteristics and premature infant pain profile (PIPP). Physiological data were recorded by the pulse oximeter immediately before and after the intervention. The data were analyzed using SPSS18 through chi-square, ANOVA and ANCOVA, and P<0.05 was considered as significant level.Results: Before intervention, there was no significant difference between groups in the mean of heart rate, blood pressure and arterial oxygen saturation (SaO2) percentage (P>0.05). After intervention, there was no significant difference between these A, B and C groups in the mean of systolic blood pressure (70.90±8.29, 70.27±6.70 and 71.77±9.07), diastolic blood pressure (43.63±9.59, 41.77±7.10 and 44.03±10.76) and SaO2 percentage (95.20±5.20, 94.00±6.23 and 91.13±11.78), respectively (P>0.05). However, after intervention, there was a significant difference between groups of A, B and C in the mean of heart rate (146. 6±14.3, 153.70±17.5 and 155.70±17.7), respectively (P=0.01). Moreover, the mean PIPP score was 6.6±1.3, 10 ±2 and 11.4±1.9 in groups A, B and C respectively, so that a significant statistical difference was found between groups (P<0.001). Conclusions: Stimulation with MBMO is effective in reducing the pain of preterm infants, so it can be used in less invasive procedures such as vaccination.Trial registration: IRCT, IRCT20190220042771N1. Registered 18 May 2019- Retrospectively registered, https://en.irct.ir/trial/37646


Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 51
Author(s):  
C. Campen ◽  
Peter Rowe ◽  
Frans Visser

Background and Objectives: Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are ameliorated by recumbency. OI has a high prevalence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Limited data are available to guide the treatment of OI in ME/CFS patients. We and others have previously described patient-reported subjective improvement in symptoms using compression stockings. We hypothesized that these subjective reports would be accompanied by objective hemodynamic improvements. Materials and Methods: We performed a randomized crossover trial in 16 ME/CFS patients. Each underwent two 15-min head-up tilt table tests, one with and one without wearing knee-high compression stockings that provided 20–25 mm Hg compression. The order of the tests was randomized. We measured heart rate and blood pressure as well as cardiac output and cerebral blood flow (CBF) using extracranial Doppler of the internal carotid and vertebral arteries. Results: There were no differences in supine measurements between the 2 baseline measurements. There were no differences in heart rate and blood pressure at either end-tilt testing period. Compared to the test with the stockings off, the mean percentage reduction in cardiac output during the test with compression stockings on was lower, 15 (4)% versus 27 (6)% (p < 0.0001), as was the mean percentage CBF reduction, 14 (4)% versus 25 (5)% (p < 0.0001). Conclusion: In ME/CFS patients with orthostatic intolerance symptoms, cardiac output and CBF are significantly reduced during a tilt test. These abnormalities were present without demonstrable heart rate and blood pressure changes and were ameliorated by the use of compression stockings.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared


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