Norepinephrine has been recently introduced as a prophylactic vasopressor during Cesarean delivery with promising results ; However, the optimum dose for efficient prophylaxis with the least side effects is not known. In this study, we will compare three doses (0.05, 0.1, 0.15 mcg/Kg/min) of norepinephrine for prophylaxis against Post-Spinal hypotension during cesarean delivery.
Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery (CD). Using vasopressors have been considered a gold standard for prevention of post-spinal hypotension (PSH) during CD. Norepinephrine (NE) is a potent vasopressor characterized by both α adrenergic agonistic activity in addition to a weak β adrenergic agonistic activity; thus, NE is considered a vasopressor with minimal cardiac depressant effect; these pharmacological properties would make NE an attractive alternative to phenylephrine and ephedrine (the most commonly used vasopressors in obstetric anesthesia). Norepinephrine has been recently introduced as a prophylactic vasopressor during CD with promising results; However, the optimum dose for efficient prophylaxis with the least side effects is not known. In this study, we will compare three doses (0.05, 0.1, 0.15 mcg/Kg/min) of norepinephrine for prophylaxis against PSH during CD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
270
Norepinephrine infusion by rate of 0.05 mcg /Kg/min after spinal anesthesia
Norepinephrine infusion by rate of 0.05 mcg /Kg/min after spinal anesthesia
Norepinephrine infusion by rate of 0.05 mcg /Kg/min after spinal anesthesia
Cairo University
Cairo, Egypt
incidence of postspinal hypotension
The number of patients who develop hypotension (defined as decreased SBP less than 80% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group
Time frame: 30 minutes after spinal anesthesia
heart rate
heart rate after spinal anesthesia measured in beat per minute
Time frame: 90 minutes after spinal anesthesia
vomiting
incidence of vomiting after spinal anesthesia
Time frame: 120 minutes after spinal anesthesia
nausea
incidence of nausea after spinal anesthesia
Time frame: 120 minutes after spinal anesthesia
ephedrine consumption
total amount of ephedrine consumed after spinal anesthesia
Time frame: 60 minutes after spinal anesthesia
Atropine consumption
total amount of atropine consumed after spinal anesthesia
Time frame: 60 minutes after spinal anesthesia
APGAR score
APGAR score of the delivered fetus
Time frame: 10 minutes after delivery
incidence of severe postspinal hypotension
The number of patients who develop hypotension (defined as decreased SBP less than 60% of the baseline reading during the period from intrathecal injection till delivery of the fetus) after spinal block divided by the total number in the group
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10 mg Bupivacaine intra-thecal for spinal anesthesia
Time frame: 30 minutes after spinal anesthesia
arterial blood pressure
arterial blood pressure after spinal anesthesia measured in mmHg
Time frame: 90 minutes after spinal anesthesia