Hypotension Clinical Trial
— INPEACEOfficial title:
Manually Controlled Continuous Infusion of Norepinephrine vs Phenylephrine During Spinal Anesthesia for Cesarean Section: A Double-blinded Randomized Controlled Study
The goal of this clinical trial is to compare norepinephrine and ephedrine in maintaining blood pressure during spinal anaesthesia for elective cesarean delivery. The main questions it aims to answer are: - Do phenylephrine and norepinephrine administered as manually controlled continuous infusion during elective cesarean delivery have different effects on neonatal outcome ? - Do phenylephrine and norepinephrine administered as manually controlled continuous infusion during elective cesarean delivery have different effects on maternal hemodynamics? Participants will receive either phenylephrine or norepinephrine infusion, at the time of performing spinal anesthesia, the infusion rate will be adjusted manually depending on maternal arterial pressure.
Status | Not yet recruiting |
Enrollment | 140 |
Est. completion date | June 30, 2024 |
Est. primary completion date | June 15, 2024 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years to 45 Years |
Eligibility | Inclusion Criteria: - Full-term, singleton, pregnant women, nonlaboring. - Scheduled for elective cesarean delivery under spinal anesthesia, - American Society of Anesthesiologists physical status : 1 or 2 - Baseline systolic BP between 90 and 140 mm Hg. Exclusion Criteria: - Known fetal abnormality. - Preexisting or pregnancy-induced hypertension, cardiovascular, cerebrovascular or kidney disease. - Contraindication to spinal anesthesia. - Peripartum hemorrhage. - Body mass index above 40 kg/m2. |
Country | Name | City | State |
---|---|---|---|
Morocco | University hospital Hassan II | Fes |
Lead Sponsor | Collaborator |
---|---|
Hassan II University |
Morocco,
Belin O, Casteres C, Alouini S, Le Pape M, Dupont A, Boulain T. Manually Controlled, Continuous Infusion of Phenylephrine or Norepinephrine for Maintenance of Blood Pressure and Cardiac Output During Spinal Anesthesia for Cesarean Delivery: A Double-Blinded Randomized Study. Anesth Analg. 2023 Mar 1;136(3):540-550. doi: 10.1213/ANE.0000000000006244. Epub 2022 Oct 24. — View Citation
Doherty DG, Norris S, Madrigal-Estebas L, McEntee G, Traynor O, Hegarty JE, O'Farrelly C. The human liver contains multiple populations of NK cells, T cells, and CD3+CD56+ natural T cells with distinct cytotoxic activities and Th1, Th2, and Th0 cytokine secretion patterns. J Immunol. 1999 Aug 15;163(4):2314-21. — View Citation
Hasanin A, Aiyad A, Elsakka A, Kamel A, Fouad R, Osman M, Mokhtar A, Refaat S, Hassabelnaby Y. Leg elevation decreases the incidence of post-spinal hypotension in cesarean section: a randomized controlled trial. BMC Anesthesiol. 2017 Apr 24;17(1):60. doi: 10.1186/s12871-017-0349-8. — View Citation
Heesen M, Stewart A, Fernando R. Vasopressors for the treatment of maternal hypotension following spinal anaesthesia for elective caesarean section: past, present and future. Anaesthesia. 2015 Mar;70(3):252-7. doi: 10.1111/anae.13007. Epub 2015 Jan 13. No abstract available. — View Citation
Mohta M, Dubey M, Malhotra RK, Tyagi A. Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section. Int J Obstet Anesth. 2019 May;38:25-31. doi: 10.1016/j.ijoa.2018.12.002. Epub 2018 Dec 13. — View Citation
Ngan Kee WD, Lee SW, Ng FF, Tan PE, Khaw KS. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015 Apr;122(4):736-45. doi: 10.1097/ALN.0000000000000601. — View Citation
Ngan Kee WD, Lee SWY, Ng FF, Khaw KS. Prophylactic Norepinephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery. Anesth Analg. 2018 Jun;126(6):1989-1994. doi: 10.1213/ANE.0000000000002243. Erratum In: Anesth Analg. 2019 Apr;128(4):e60. — View Citation
Ngan Kee WD. A Random-allocation Graded Dose-Response Study of Norepinephrine and Phenylephrine for Treating Hypotension during Spinal Anesthesia for Cesarean Delivery. Anesthesiology. 2017 Dec;127(6):934-941. doi: 10.1097/ALN.0000000000001880. — View Citation
Ngan Kee WD. Phenylephrine infusions for maintaining blood pressure during spinal anesthesia for cesarean delivery: finding the shoe that fits. Anesth Analg. 2014 Mar;118(3):496-8. doi: 10.1213/ANE.0000000000000111. No abstract available. — View Citation
Onwochei DN, Ngan Kee WD, Fung L, Downey K, Ye XY, Carvalho JCA. Norepinephrine Intermittent Intravenous Boluses to Prevent Hypotension During Spinal Anesthesia for Cesarean Delivery: A Sequential Allocation Dose-Finding Study. Anesth Analg. 2017 Jul;125(1):212-218. doi: 10.1213/ANE.0000000000001846. — View Citation
Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg. 2010 Nov;111(5):1230-7. doi: 10.1213/ANE.0b013e3181f2eae1. Epub 2010 Sep 14. — View Citation
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Veeser M, Hofmann T, Roth R, Klohr S, Rossaint R, Heesen M. Vasopressors for the management of hypotension after spinal anesthesia for elective caesarean section. Systematic review and cumulative meta-analysis. Acta Anaesthesiol Scand. 2012 Aug;56(7):810-6. doi: 10.1111/j.1399-6576.2011.02646.x. Epub 2012 Feb 7. Erratum In: Acta Anaesthesiol Scand. 2012 Oct;56(9):1204. — View Citation
* Note: There are 13 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Umbilical artery pH | Umbilical arterial blood (UA) will be sampled from a double-clamped segment of umbilical cord by using arterial blood gas syringes.Umbilical blood gas will be analyzed with a bedside Blood gas Analyzer System. | Immediately after delivery | |
Secondary | Umbilical artery base excess | From umbilical arterial blood gases. | Immediately after delivery | |
Secondary | Umbilical artery partial pressure of oxygen | From umbilical arterial blood gases. | Immediately after delivery | |
Secondary | Umbilical artery partial pressure of carbon dioxide | From umbilical arterial blood gases | Immediately after delivery | |
Secondary | APGAR score | A= Appearance P=Pulse G=Grimace A=Attitude R=Respiration. Values of APGAR score vary from 0 to 10, higher scores mean a better outcome. | 1 min after delivery | |
Secondary | APGAR score | A= Appearance P=Pulse G=Grimace A=Attitude R=Respiration. Values of APGAR score vary from 0 to 10, higher scores mean a better outcome. | 5 min after delivery | |
Secondary | Number of newborns admitted to neonatal intensive care unit | Admission of the newborn to the neonatal intensive care unit | Within 24 hours after delivery | |
Secondary | Blood glucose level from arterial umbilical cord blood gases | from arterial umbilical cord blood gases | Immediately after delivery | |
Secondary | Number of hypotensive episodes | Defined as decreased systolic blood pressure intraoperatively less than 80% of the baseline or less than 90 mmhg | from intrathecal injection to delivery of the fetus | |
Secondary | Number of severe hypotensive episodes. | Defined as decreased systolic blood pressure intraoperatively less than 60% of the baseline or less than 70 mmhg | from intrathecal injection to delivery of the fetus | |
Secondary | Number of episodes of bradycardia before delivery | Heart rate less than 60 beats per minute | From intrathecal injection to delivery of the fetus. | |
Secondary | Number of Hypertension episodes | Systolic blood pressure at or above 120% of baseline | In the intraoperative period. | |
Secondary | Number of episodes of Tachycardia | Heart rate greater than 30% of baseline. | In the intraoperative period. | |
Secondary | Number of episodes of nausea | episodes of nausea experienced by patients | From induction of spinal anesthesia to the end of the cesarean section. | |
Secondary | Number of episodes of vomiting | Episodes of vomiting experienced by patients | From induction of spinal anesthesia to the end of the cesarean section. | |
Secondary | Total dose of study drug given until delivery of the fetus. | The total dose given of norepinephrine or phenylephrine depending on randomization | From induction of spinal anesthesia to the delivery of the fetus | |
Secondary | Total dose of intraoperative study drug given. | The total dose given of norepinephrine or phenylephrine depending on randomization | From induction of spinal anesthesia to the end of the cesarean section. | |
Secondary | Total dose of ephedrine from induction of spinal anesthesia to delivery of the fetus. | Total dose of corrective boluses of ephedrine as a rescue drug | from induction of spinal anesthesia to delivery of the fetus. | |
Secondary | Total dose of intraoperative corrective boluses of ephedrine | Total dose of corrective boluses of ephedrine as a rescue drug | From induction of spinal anesthesia to the end of the cesarean section. | |
Secondary | Total dose of corrective boluses of atropine from induction of spinal anesthesia to delivery of the fetus. | Total dose of corrective boluses of atropine in case of bradycardia | from induction of spinal anesthesia to delivery of the fetus. | |
Secondary | Total dose of Intraoperative corrective boluses of atropine | Total dose of corrective boluses of atropine in case of bradycardia | From induction of spinal anesthesia to the end of the cesarean section. |
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