Norepinephrine Prophylaxis for Postspinal Anesthesia Hypotension in Parturients With Preeclampsia

Adverse Effect Clinical Trial

Official title:

Norepinephrine Prophylaxis for Postspinal Anesthesia Hypotension in Parturients With Preeclampsia Undergoing Cesarean Section: a Randomized, Controlled Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04556357
• Other study ID #: Yi Chen-2020-4
• Status: Completed
• Phase: N/A
• Start date: September 22, 2020
• Est. completion date: November 15, 2021

Study information

• Verified date: September 2020
• Source: General Hospital of Ningxia Medical University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to investigate the efficacy and safety of norepinephrine for prophylaxis against postspinal anesthesia hypotension in parturients with preeclampsia undergoing cesarean section.

Description:

Preeclampsia, which affects 5% to 7% of parturients, is a significant cause of maternal and neonatal morbidity and mortality. Because of constricted myometrial spiral arteries with exaggerated vasomotor responsiveness, though blood pressure in parturients with preeclampsia are apparently higher than healthy parturients, placental hypoperfusion is more common. Spinal anesthesia is still the preferred mode of anesthesia in parturients with preeclampsia for cesarean section. In preeclampsia parturients, spinal anesthesia improve intervillous blood flow (provided that hypotension is avoided) which contribute to increase placental perfusion. Even so, 17-26% parturients with preeclampsia experienced postspinal anesthesia hypotension due to the extensive sympathetic block that occurred with spinal anesthesia. As a potential substitute drug for phenylephrine and ephedrine, norepinephrine has gained traction for use in parturients undergoing cesarean section. But the efficacy and safety in parturients with preeclampsia is still unknown. The purpose of this study is to investigate the efficacy and safety of norepinephrine for prophylaxis against post-spinal anesthesia hypotension in parturients with preeclampsia undergoing cesarean section.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 138
• Est. completion date: November 15, 2021
• Est. primary completion date: November 15, 2021
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 18 Years to 45 Years

Eligibility

Criteria: Inclusion Criteria:

• 18-45 years
• Primipara or multipara
• Singleton pregnancy =32 weeks
• American Society of Anesthesiologists physical status classification II to III
• Scheduled for cesarean section under spinal anesthesia

Exclusion Criteria:

• Baseline blood pressure =180 mmHg
• Body height < 150 cm
• Body weight > 100 kg or body mass index (BMI) = 40 kg/m2
• Eclampsia or chronic hypertension
• Hemoglobin < 7g/dl
• Fetal distress, or known fetal developmental anomaly

Related Conditions & MeSH terms

• Adverse Effect
• Hypotension
• Pre-Eclampsia

Intervention

Drug:
• Phenylephrine
A maintenance dose of phenylephrine (0.625 µg/kg/min) infusion simultaneous with subarachnoid block
• Norepinephrine
A maintenance dose of norepinephrine (0.05 µg/kg/min) infusion simultaneous with subarachnoid block

Locations

Country	Name	City	State
China	General Hospital of Ningxia Medical University	Yinchuan	Ningxia

Sponsors (1)

Lead Sponsor	Collaborator
General Hospital of Ningxia Medical University

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Overall stability of heart rate control versus baseline	Evaluated by performance error (PE)	1-15 minutes after spinal anesthesia
Other	The incidence of postspinal anesthesia hypotension	Systolic blood pressure (SBP) < 80% of the baseline	1-15 minutes after spinal anesthesia
Other	The incidence of severe post-spinal anesthesia hypotension	Systolic blood pressure (SBP) < 60% of the baseline	1-15 minutes after spinal anesthesia
Other	The incidence of nausea and vomiting.	Presence of nausea and vomiting in patients after spinal anesthesia	1-15 minutes after spinal anesthesia
Other	The incidence of hypertension	Systolic blood pressure (SBP) >120% of the baseline.	1-15 minutes after spinal anesthesia
Other	pH	From umbilical arterial blood gases.	Immediately after delivery
Other	Partial pressure of oxygen	From umbilical arterial blood gases.	Immediately after delivery
Other	Base excess	From umbilical arterial blood gases.	Immediately after delivery
Other	APGAR score	A= Appearance P=Pulse G=Grimace A=Attitude R=Respiration	1 min after delivery
Other	APGAR score	A= Appearance P=Pulse G=Grimace A=Attitude R=Respiration	5 min after delivery
Primary	The incidence of bradycardia	Heart rate < 60 beats/min	1-15 minutes after spinal anesthesia.
Secondary	Overall stability of systolic blood pressure control versus baseline	Evaluated by performance error (PE)	1-15 minutes after spinal anesthesia