Comparison will be conducted between continuous variable infusions of both drugs (Phenylephrine and Norepinephrine) with starting doses of 0.75 mcg/Kg/min and 0.1 mcg/Kg/min respectively for prophylaxis against Post-spinal hypotension during cesarean delivery.
Maternal hypotension is a common complication after spinal anesthesia for cesarean delivery (CD). Many vasopressors have been used for prevention of post-spinal hypotension (PSH) during CD; however, the optimum protocol for prophylaxis is not established yet. Phenylephrine (PE) is a popular vasopressor used in obstetric anesthesia; however, its use is limited by its marked cardiac depressant nature. 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 PE. In this study, we will compare continuous variable infusion of both drugs (PE and NE) with doses of 0.75 mcg/Kg/min and 0.1 mcg/Kg/min respectively for prophylaxis against PSH during CD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
120
Phenylephrine variable infusion with a starting rate of 0.75 mcg/Kg/min.
Norepinephrine variable infusion with a starting rate of 0.1 mcg/Kg/min.
Bupivacaine will be injected in the subarachnoid space with a dose of 10 mg
Cairo University
Cairo, Egypt
RECRUITINGincidence of post-spinal anesthesia hypotension
Defined as the percentage of patients with decreased systolic blood pressure less than 80% of the baseline reading
Time frame: 30 minutes after spinal anesthesia
incidence of severe post-spinal anesthesia hypotension
Defined as the percentage of patients with decreased systolic blood pressure less than 60% of the baseline reading
Time frame: 30 minutes after spinal anesthesia
incidence of severe delivery hypotension
Defined as the percentage of patients with decreased systolic blood pressure less than 80% of the baseline reading
Time frame: 10 minutes after delivery
systolic blood pressure
systolic blood pressure measured in mmHg
Time frame: 2 hours after subarachnoid block
diastolic blood pressure
diastolic blood pressure measured in mmHg
Time frame: 2 hours after subarachnoid block
heart rate
number of heart beats per minute
Time frame: 2 hours after subarachnoid block
APGAR score
APGAR score of the fetus
Time frame: 10 minutes after delivery
incidence of reactive hypertension
Defined as the percentage of patients with increased systolic blood pressure more than 80% of the baseline reading
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Time frame: 2 hours after spinal anesthesia