BACKGROUND: Prevention of hemodynamic instability during cesarean delivery during spinal anesthesia has been the aim of several studies. Noninvasive monitoring has been used in all previous studies. This is the first study in healthy pregnant women with continuous invasive recording of arterial blood pressure, cardiac output, and systemic vascular resistance. The aim of this randomized trial was to compare the effects of two different intrathecal doses of bupivacaine, with or without intravenous phenylephrine infusion, on cardiac output and systolic blood pressure. METHODS: In this double-blinded study, 80 healthy women scheduled to undergo elective cesarean delivery were randomly assigned to one of four different groups receiving 7 mg spinal bupivacaine with or without a concomitant low-dose infusion of phenylephrine (0.25 microg . kg(-1) . min(-1)) or 10 mg spinal bupivacaine with or without phenylephrine infusion. All patients had 4 microg sufentanil added to the spinal solution and had cohydration with 750 ml saline, 0.9%. RESULTS: The low-dose spinal bupivacaine group with intravenous phenylephrine infusion was the most stable group regarding all hemodynamic variables. The authors found significant differences between this group and the group that was given the high dose of bupivacaine with intravenous placebo infusion regarding cardiac output (P = 0.005), systemic vascular resistance (P < 0.0001), and systolic blood pressure (P = 0.012). CONCLUSIONS: This study shows that low-dose bupivacaine (with sufentanil), combined with a low-dose infusion of phenylephrine and moderate cohydration, gives the best hemodynamic stability during spinal anesthesia for cesarean delivery.
RCT Entities:
BACKGROUND: Prevention of hemodynamic instability during cesarean delivery during spinal anesthesia has been the aim of several studies. Noninvasive monitoring has been used in all previous studies. This is the first study in healthy pregnant women with continuous invasive recording of arterial blood pressure, cardiac output, and systemic vascular resistance. The aim of this randomized trial was to compare the effects of two different intrathecal doses of bupivacaine, with or without intravenous phenylephrine infusion, on cardiac output and systolic blood pressure. METHODS: In this double-blinded study, 80 healthy women scheduled to undergo elective cesarean delivery were randomly assigned to one of four different groups receiving 7 mg spinal bupivacaine with or without a concomitant low-dose infusion of phenylephrine (0.25 microg . kg(-1) . min(-1)) or 10 mg spinal bupivacaine with or without phenylephrine infusion. All patients had 4 microg sufentanil added to the spinal solution and had cohydration with 750 ml saline, 0.9%. RESULTS: The low-dose spinal bupivacaine group with intravenous phenylephrine infusion was the most stable group regarding all hemodynamic variables. The authors found significant differences between this group and the group that was given the high dose of bupivacaine with intravenous placebo infusion regarding cardiac output (P = 0.005), systemic vascular resistance (P < 0.0001), and systolic blood pressure (P = 0.012). CONCLUSIONS: This study shows that low-dose bupivacaine (with sufentanil), combined with a low-dose infusion of phenylephrine and moderate cohydration, gives the best hemodynamic stability during spinal anesthesia for cesarean delivery.
Authors: J Jokinen; V Adametz; M Kredel; R M Muellenbach; A Hönig; A Wöckel; J Dietl; N Roewer; P Kranke Journal: Anaesthesist Date: 2014-12-25 Impact factor: 1.041
Authors: Luis E Okamoto; André Diedrich; Franz J Baudenbacher; René Harder; Jonathan S Whitfield; Fahad Iqbal; Alfredo Gamboa; Cyndya A Shibao; Bonnie K Black; Satish R Raj; David Robertson; Italo Biaggioni Journal: Hypertension Date: 2016-06-06 Impact factor: 10.190
Authors: Yanhong Liu; May C M Pian-Smith; Lisa R Leffert; Rebecca D Minehart; Andrea Torri; Charles Coté; Robert M Kacmarek; Yandong Jiang Journal: J Clin Monit Comput Date: 2014-12-16 Impact factor: 2.502
Authors: José Otavio Costa Auler; Marcelo L A Torres; Mônica M Cardoso; Thais C Tebaldi; André P Schmidt; Mario M Kondo; Marcelo Zugaib Journal: Clinics (Sao Paulo) Date: 2010-06 Impact factor: 2.365