Maternal hypotension and fetal outcome: effect of height-adjusted and weight-adjusted dose versus fixed dose of 0.5% intrathecal hyperbaric bupivacaine

2021 ◽  
Vol 8 (1) ◽  
pp. 52
Author(s):  
OyebolaO Adekola ◽  
AdekunleO Durodola ◽  
PamelaA Agbamu ◽  
OlusolapeO Akinwilliams ◽  
JohnO Olatosi
Keyword(s):  
Fetal Outcome ◽  
Fixed Dose ◽  
Hyperbaric Bupivacaine ◽  
Adjusted Dose

scholarly journals Fixed-dose versus height and weight-adjusted dose of intrathecal 0.5% hyperbaric bupivacaine in elective cesarean section: A comparative study

2020 ◽  
Vol 6 (2) ◽  
pp. e217
Author(s):  
Kiran Kumar K.C. ◽  
Amir Babu Shrestha ◽  
Sangeeta Shrestha
Keyword(s):  
Cesarean Section ◽  
Onset Time ◽  
Elective Cesarean Section ◽  
Fixed Dose ◽  
Distinct Advantage ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Calculated Dose ◽  
Elective Cesarean ◽  
Adjusted Dose

Background: Spinal anesthesia is the preferred anesthetic technique for cesarean deliveries. But there is a dosage dilemma regarding block to the desired level and preventing hypotension. We aim to study effects of fixed dose with height and weight-adjusted dose of intrathecal 0.5% hyperbaric bupivacaine during elective cesarean section. Methods: Eighty-eight singleton term parturients were enrolled and divided into two groups, Group FD (Fixed Dose) and CD (Calculated Dose) in this prospective, double-blind, randomized controlled trial. Group FD received 2.2 ml and CD received a height and weight adjusted calculated dose based on Harten's chart. Hemodynamic changes, onset time to sensory block to T6, maximum block in 20 minutes, and adverse effects were compared. Results: There was a significant reduction in median drug dosage of 11mg in FD versus 9 mg in CD group. The decrease in the MAP was less in group CD (14.5±2.98) mmHg compared to (17.6±4.66) mmHg in group FD (P= 0.03). The median onset time of spinal block to T6 in group FD of 2 minutes with IQR (2-3) was faster than Group CD 4 minutes with IQR (3-5). The spinal block extended above T4 in the larger number of parturients 23 (52 %) in Group FD than in three (6.8%) in group CD (p<0.05). Significantly larger number 20 (45.45 %) in group FD developed hypotension than seven (15.9 %) in Group CD. Bradycardia and vomiting were also found in group FD. Conclusions: This calculated dose provided the desired level of the spinal block and also restricted spinal block level with a distinct advantage of less hypotension.

scholarly journals Fixed Dose versus Height-Adjusted Conventional Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery: A Prospective, Double-Blinded Randomised Trial

2020 ◽  
Vol 9 (11) ◽  
pp. 3600
Author(s):  
Katarzyna Białowolska ◽  
Bartosz Horosz ◽  
Agnieszka Sękowska ◽  
Małgorzata Malec-Milewska
Keyword(s):  
Spinal Anaesthesia ◽  
Dose Regimen ◽  
Dose Group ◽  
Randomised Trial ◽  
Sensory Block ◽  
Fixed Dose ◽  
Spinal Block ◽  
Success Rates ◽  
Hyperbaric Bupivacaine ◽  
Adjusted Dose

The optimal intrathecal dose of local anaesthetic for caesarean section (CS) anaesthesia is still being debated. We performed a study to compare the effectiveness and safety of spinal anaesthesia with 12.5 mg of hyperbaric bupivacaine and a dosing regimen of conventional doses adjusted to parturient height. One hundred and forty parturients scheduled for elective CS were enrolled. The fixed-dose group (FD) received a spinal block with 12.5 mg of hyperbaric bupivacaine with fentanyl, whereas the adjusted-dose group (AD) received a height-adjusted dose of bupivacaine (9–13 mg) with fentanyl. Sensory block ≥ T5 dermatome within 10 min and no need for supplementary analgesia were set as the composite primary outcome (success). Rates of successful blocks and complications were compared. Complete data were available for 134 cases. Spinal anaesthesia was successful in 58 out of 67 patients in the FD group and 57 out of 67 in the AD group (p > 0.05). Eight spinals in each group failed to produce a block ≥ T5 in 10 min, and one patient in the FD group and two in the AD group required i.v. analgesics despite sensory block ≥ T5. No differences were noted in terms of hypotension, bradycardia and nausea between the FD and AD groups. Compared to the height-adjusted dose regimen based on conventional doses of hyperbaric bupivacaine, the fixed dose regimen of 12.5 mg was equally effective and did not increase the risk of spinal block-related complications.

Evaluation of an Alternate Dosing Strategy for Cisplatin in Patients With Extreme Body Surface Area Values

2006 ◽  
Vol 24 (10) ◽  
pp. 1499-1506 ◽  
Author(s):  
Walter J. Loos ◽  
Felix E. de Jongh ◽  
Alex Sparreboom ◽  
Ronald de Wit ◽  
Desiree M. van Boven-van Zomeren ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Drug Exposure ◽  
Normal Population ◽  
Fixed Dose ◽  
Interpatient Variability ◽  
Average Patient ◽  
Dosing Strategy ◽  
Adjusted Dose

Purpose The majority of cytotoxic drugs for adults are dosed based on body surface area (BSA), aiming to reduce interpatient variability in drug exposure. We prospectively studied the usefulness of BSA-based dosing of cisplatin in patients at extremes of BSA values. Patients and Methods Patients were randomly assigned to receive a fixed dose of cisplatin in course 1, and a BSA-adjusted dose in course 2, or vice versa. The fixed dose was based on the average BSA for males and females, while extremes were set at BSA values exceeding the average ± 1 standard deviation. Subsequently, we retrospectively analyzed data from a normal population. Results In 25 patients assessable for both courses, the use of a fixed dose of cisplatin resulted in reduced exposure to unbound platinum in patients at the upper extremes of BSA (P = .003) and higher exposures in patients at the lower extremes (P = .009), as compared with exposures following the BSA-adjusted dose. Although clearance was related to BSA (R2 = 0.44; P < .001), only a small reduction in interpatient variability in clearance after correction for BSA was achieved (20.8% v 17.1%). In the retrospective analysis, compared with the average patient, the clearance of unbound platinum in patients with a BSA value ≤ 1.65 m2 was 16% slower (P < .001), while an 18% faster clearance (P < .001) was observed in patients with a BSA value ≥ 2.05 m2. Conclusion Unless better predictors for platinum clearance are identified, fixed-dose regimens per BSA cluster (≤ 1.65 m2; 1.66 m2 to 2.04 m2; ≥ 2.05 m2) are recommended.

Dose calculation of anticancer drugs: a review of the current practice and introduction of an alternative.

1996 ◽  
Vol 14 (9) ◽  
pp. 2590-2611 ◽  
Author(s):  
H Gurney
Keyword(s):  
Calculation Method ◽  
Surrogate Marker ◽  
Drug Effects ◽  
Dose Calculation ◽  
Cytotoxic Drugs ◽  
Fixed Dose ◽  
Therapeutic Drug ◽  
Clinical Dose ◽  
Drug Handling ◽  
Adjusted Dose

PURPOSE To review the current dose-calculation practice and propose a non-body-surface area (BSA)-based dose-calculation method. METHODS Data that supported the introduction of BSA-based dose calculation in the late 1950s were reviewed. Data on 18 drugs that correlated pharmacokinetic (PK) variables for cytotoxic drugs with BSA were examined. Other methods of dose calculation, such as therapeutic drug monitoring (TDM) and adaptive control, were also examined. RESULTS The BSA-based method of dose calculation was adopted without adequate investigation of its accuracy. BSA fails to standardize the marked interpatient variation in PK for most cytotoxic drugs. A definite correlation was found between PK variables and BSA for only one drug (docetaxel). PK parameters correlate with toxicity, as well as response in some tumors, but do not completely explain the variation in drug effect between individuals. The complexities of TDM may make its universal use impractical. A non-BSA-based dose calculation method is proposed that defines three mandatory steps: prime dose, modified dose, and toxicity-adjusted dose (PMT dosing). Prime dose is the fixed dose of a drug used alone or in combination and is derived from the reanalysis of phase I/II studies and from clinical practice. Modified dose is an adjustment of the prime dose before administration, based on dose-adjustment guidelines that predict the drug-handling ability of an individual. Population pharmacodynamic studies may be used for the development of these guidelines. Subsequent doses are adjusted in each patient according to a target toxicity, such as nadir neutrophil count or other objective toxicity, that serves as a surrogate marker for potential antitumor effect (toxicity-adjusted dose). Patients who are predicted to have very abnormal drug handling should be excluded from such a dosing scheme and TDM may be more suitable. CONCLUSION The routine use of BSA for dose calculation should be reevaluated. Other methods of dose calculation should be investigated. TDM may be impractical in all patients and remains unvalidated. PMT dosing ensures that the condition of each individual is considered, to predict drug effects better. Clinical dose-calculation systems such as PMT dosing should be evaluated prospectively.

Adjusting enoxaparin dosage according to anti-FXa levels and pregnancy outcome in thrombophilic women

2016 ◽  
Vol 116 (10) ◽  
pp. 687-695 ◽  
Author(s):  
Zohar Nachum ◽  
Israel Gavish ◽  
Shabtai Romano ◽  
Meirav Braverman ◽  
Gali Garmi ◽  
...  
Keyword(s):  
Dose Group ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Factor Xa ◽  
Preterm Births ◽  
Fixed Dose ◽  
Composite Outcome ◽  
Increased Risk ◽  
Gestational Age At Delivery ◽  
Adjusted Dose

SummaryWomen with thrombophilias and previous placenta-mediated pregnancy complications (PMPC) have an increased risk of both recurrent PMPC and venous thromboembolism (VTE) during subsequent pregnancies. We aimed to examine whether enoxaparin dose adjusted according to anti-factor Xa levels compared to a fixed dose would reduce the risk of PMPC in subsequent pregnancies. In a randomised trial, conducted at a single teaching hospital, pregnant women with thrombophilia and previous PMPC were enrolled in a 1:1 ratio to either a fixed dose of 40 mg daily enoxaparin or adjusted dose according to anti-factor Xa plasma levels. The primary outcome was a composite that included any of the following: pregnancy loss after enrollment, pre-eclampsia, birthweight <10th percentile, placental abruption, or VTE. Overall, 144 women were needed to detect a decrease of 20 % in the incidence of the composite outcome among the adjusted dose group. Between 2009 and 2015, 144 women consented; four in the fixed-dose group were excluded. Overall, 66 and 74 in the fixed- and adjusted-dose groups, respectively, were included. Demographic and obstetric characteristics were comparable. Composite outcome occurred in 12 (18.2 %) and 20 (27.0 %) women in the fixed- and adjusted-dose groups, respectively (p=0.24). Gestational age at delivery, preterm births, and birthweights were similar between the two groups. In conclusion, dose of enoxaparin adjusted according to anti-factor Xa levels compared to fixed dose, does not reduce the risk of PMPC recurrence in thrombophilic women.ClinicalTrial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01068795.

scholarly journals The effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section

2011 ◽  
Vol 51 (181) ◽  
Author(s):  
A Subedi ◽  
M Tripathi ◽  
BK Bhattarai ◽  
PK Gupta ◽  
K Pokharel ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Elective Caesarean Section ◽  
Onset Time ◽  
Distinct Advantage ◽  
Spinal Block ◽  
Hyperbaric Bupivacaine ◽  
Number Of Patients ◽  
Block Level ◽  
Adjusted Dose

Introduction: The study compared spinal anesthesia using intrathecal hyperbaric bupivacaine between height and weight adjusted dose and fi xed dose during caesarean section. Methods: A hundred parturients, who had given their consent and were scheduled for elective caesarean section under spinal anesthesia, were randomly assigned into two groups. We adjusted the intrathecal dose of heavy bupivacaine (0.5 %) according to the height and weight of patients (Group AD) from Harten’s dose chart developed from the Caucasian parturients and the fi xed dose (2.2 ml) was used in Group FD patients. Keeping the observer blinded to the study groups, the onset time to sensory block up to T5, haemodynamic changes, side effects, and fetal outcome were observed. Results: The median onset time of spinal block in Group FD was faster than in Group AD (6 min vs. 4 min; p = 0.01). The spinal block level extended above T3 level in a signifi cantly (p < 0.05) larger number of patients 12 (24 %) in Group FD than in one (2 %) patient in Group AD. A signifi cantly (p < 0.05) larger number of patients, 32, (64 %) in Group FD had hypotension than in 15 (30 %) patients in Group AD. The lowest recorded SAP (101 ± 6 mm Hg) in Group AD was higher than in Group FD (96 ± 6.7 mm Hg). Nausea and vomiting were more pronounced in Group FD patients. Conclusions: The bupivacaine dose was signifi cantly reduced on its dose adjustment for the body weight and height of patients for cesearean section. This adjusted-dose use suitably restricted spinal block level for cesarean section with a distinct advantage of less hypotension and with a similar neonatal outcome as fi xed compared with the dose use. keywords: caesarean section; low-dose hyperbaric bupivacaine; spinal anesthesia.

scholarly journals Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease

2019 ◽  
Author(s):  
Isngadi Isngadi ◽  
Rudi Hartono ◽  
Dewi Puspitorini Husodo ◽  
Eka Sunarwidhi Prasedya
Keyword(s):  
Heart Disease ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Apgar Score ◽  
Low Dose ◽  
Fetal Outcome ◽  
Post Injection ◽  
Physiological Changes ◽  
Hyperbaric Bupivacaine ◽  
Metabolic System

Background & Aims: Most of the women with cardiovascular diseases suffer from worsening of their clinical condition during pregnancy. It is caused by cardiovascular physiological changes during pregnancy and increased demand of oxygen-metabolic system. Spinal anesthesia is the most commonly used technique in cesarean section (CS) patients, but there are concerns about sudden hemodynamic decrease. We aimed to investigate the use of low dose hyperbaric bupivacaine 5 mg combined with 50 μg fentanyl for caesarean section in patient with heart disease.Methodology: This study is a retrospective study in 33 patients with maternal heart disease undergoing CS under low dose spinal anesthesia in Saiful Anwar Hospital Malang Indonesia from September 2017 until September 2018. The spinal regimen was administered with 5 mg bupivacaine heavy 0.5% combined with 50 μg fentanyl. We evaluated the hemodynamic preoperative, post injection of spinal anesthetics, postdelivery, and at the end of surgery. We also evaluated Bromage score, Apgar score of the baby, and satisfaction level by the obstetrician.Results: Combination of low dose spinal and opioid for the CS delivery show no significant hypotension effects. Hemodynamic stabilization was achieved. Furthermore, target blocked was reached well in all cases, no significant changes in Apgar score of the baby, and obstetrician satisfied with motor relaxation.Conclusion: Low dose spinal anesthesia using 5 mg of bupivacaine heavy 0.5% and adjuvant opioid fentanyl 50 μg can be successfully used for the performance of CS delivery satisfactory block, good fetal outcome, and impressive cardiovascular stability.Citation: Husodo DP, Isngadi I, Hartono R, Prasedya ES. Low dose hyperbaric bupivacaine 5 mg combined with 50 mcg fentanyl for cesarean section in maternal heart disease. Anaesth pain & intensive care 2019;23(3):274-278

Effectiveness of Coumadin for Secondary Prophylaxis in Patients with Established Venous Thrombosis(DVT)

1979 ◽  
Author(s):  
R. Hull ◽  
E. Genton ◽  
J. Hirsh ◽  
T. Delmore ◽  
M. Gent ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Oral Anticoagulants ◽  
Randomized Study ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fixed Dose ◽  
Subcutaneous Heparin ◽  
Special Clinic ◽  
Adjusted Dose

The evidence to support the use of oral anticoagulants to prevent recurrent venous thrombosis is not conclusive because it is based on one single non-randomized study. We have performed a study in 68 patients with acute DVT confirmed by venography. All patients were treated with full doses of heparin For 14 days and then randomized into either adjusted dose Coumadin therapy (prothrombin time 1½-twice control) or fixed dose subcutaneous heparin, 5,000 units 12 hrly for 12 weeks. The patients were followed in a special clinic and routinely screened with leg scanning and impedance plethysmography at 3 weekly intervals and were seen on an emergency basis if they developed recurrent symptoms. Eight of 35 patients on subcutaneous heparin (23%) developed a new episode of DVT confirmed by venography and one patient developed recurrent pulmonary embolism confirmed by ventilation perfusion lung scan. There were no detectable episodes of venous thrombosis or pulmonary embolism in the 33 patients treated with Coumadin (p<0.001). Seven of 33 patients treated with Coumadin developed bleeding complications, 4 of which were major, compared with no patients receiving subcutaneous heparin (p<0.002). Thus, adjusted dose Coumadin therapy is more effective than fixed low dose subcutaneous heparin in preventing recurrent venous thromboembolism but at a significant risk of bleeding in this patient group.

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