Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia
BACKGROUND:Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypot...
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| Veröffentlicht in: | Anesthesia and analgesia 2020-01, Vol.130 (1), p.187-193 |
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| creator | Xiao, Fei Shen, Bei Xu, Wen-ping Feng, Ying Ngan Kee, Warwick D Chen, Xin-zhong |
| description | BACKGROUND:Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight.
METHODS:Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal–epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to |
| doi_str_mv | 10.1213/ANE.0000000000004092 |
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METHODS:Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal–epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.
RESULTS:Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups.
CONCLUSIONS:Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/ANE.0000000000004092</identifier><identifier>PMID: 30829668</identifier><language>eng</language><publisher>United States: International Anesthesia Research Society</publisher><subject>Adrenergic alpha-1 Receptor Agonists - administration & dosage ; Adrenergic alpha-1 Receptor Agonists - adverse effects ; Anesthesia, Epidural - adverse effects ; Anesthesia, Obstetrical ; Anesthesia, Spinal - adverse effects ; Blood Pressure - drug effects ; Body Weight ; Cesarean Section - adverse effects ; China ; Dose-Response Relationship, Drug ; Double-Blind Method ; Drug Dosage Calculations ; Female ; Humans ; Hypotension - diagnosis ; Hypotension - etiology ; Hypotension - physiopathology ; Hypotension - prevention & control ; Infusions, Intravenous ; Parturition ; Phenylephrine - administration & dosage ; Phenylephrine - adverse effects ; Pregnancy ; Time Factors ; Treatment Outcome ; Vasoconstrictor Agents - administration & dosage ; Vasoconstrictor Agents - adverse effects</subject><ispartof>Anesthesia and analgesia, 2020-01, Vol.130 (1), p.187-193</ispartof><rights>2020 International Anesthesia Research Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4682-22f5fc88b7dfd84fc053a701f8f37f5767126facc9fee23f60d0df6703b50bbd3</citedby><cites>FETCH-LOGICAL-c4682-22f5fc88b7dfd84fc053a701f8f37f5767126facc9fee23f60d0df6703b50bbd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30829668$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xiao, Fei</creatorcontrib><creatorcontrib>Shen, Bei</creatorcontrib><creatorcontrib>Xu, Wen-ping</creatorcontrib><creatorcontrib>Feng, Ying</creatorcontrib><creatorcontrib>Ngan Kee, Warwick D</creatorcontrib><creatorcontrib>Chen, Xin-zhong</creatorcontrib><title>Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>BACKGROUND:Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight.
METHODS:Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal–epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.
RESULTS:Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups.
CONCLUSIONS:Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively.</description><subject>Adrenergic alpha-1 Receptor Agonists - administration & dosage</subject><subject>Adrenergic alpha-1 Receptor Agonists - adverse effects</subject><subject>Anesthesia, Epidural - adverse effects</subject><subject>Anesthesia, Obstetrical</subject><subject>Anesthesia, Spinal - adverse effects</subject><subject>Blood Pressure - drug effects</subject><subject>Body Weight</subject><subject>Cesarean Section - adverse effects</subject><subject>China</subject><subject>Dose-Response Relationship, Drug</subject><subject>Double-Blind Method</subject><subject>Drug Dosage Calculations</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - diagnosis</subject><subject>Hypotension - etiology</subject><subject>Hypotension - physiopathology</subject><subject>Hypotension - prevention & control</subject><subject>Infusions, Intravenous</subject><subject>Parturition</subject><subject>Phenylephrine - administration & dosage</subject><subject>Phenylephrine - adverse effects</subject><subject>Pregnancy</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vasoconstrictor Agents - administration & dosage</subject><subject>Vasoconstrictor Agents - adverse effects</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi0EokvhDRDykUuK7SSOc1y2C61UQdVScYyceLwxOHZqJ61y4x14CN6LJ8GrLQhxYC6j-fXNPyP9CL2k5IQymr9Zf9iekL-qIDV7hFa0ZDyrylo8Rquk5hmr6_oIPYvxSxopEfwpOsqJYDXnYoV-nPoIP799v4I4ehcBX0-zWrDXuMCfwez6KXsrIyh82YNbLIx9MA7wudNzNN7hK9iZAVzE2gd8GeAO3GTcDp8to5-SvmdO57CXNhBlAJlmsOYOwoJvnIKAN35ok6fC16Nx0qZntqNRc5AWrx3EqYdo5HP0REsb4cVDP0Y377afNmfZxcf355v1RdYVXLCMMV3qToi2UlqJQnekzGVFqBY6r3RZ8YoyrmXX1RqA5ZoTRZTmFcnbkrStyo_R64PvGPztnK43g4kdWCsd-Dk2jIqqLmvGy4QWB7QLPsYAuhmDGWRYGkqafURNiqj5N6K09urhwtwOoP4s_c4kAeIA3Hs7QYhf7XwPoelB2qn_v_cvDsii3A</recordid><startdate>202001</startdate><enddate>202001</enddate><creator>Xiao, Fei</creator><creator>Shen, Bei</creator><creator>Xu, Wen-ping</creator><creator>Feng, Ying</creator><creator>Ngan Kee, Warwick D</creator><creator>Chen, Xin-zhong</creator><general>International Anesthesia Research Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202001</creationdate><title>Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia</title><author>Xiao, Fei ; Shen, Bei ; Xu, Wen-ping ; Feng, Ying ; Ngan Kee, Warwick D ; Chen, Xin-zhong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4682-22f5fc88b7dfd84fc053a701f8f37f5767126facc9fee23f60d0df6703b50bbd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adrenergic alpha-1 Receptor Agonists - administration & dosage</topic><topic>Adrenergic alpha-1 Receptor Agonists - adverse effects</topic><topic>Anesthesia, Epidural - adverse effects</topic><topic>Anesthesia, Obstetrical</topic><topic>Anesthesia, Spinal - adverse effects</topic><topic>Blood Pressure - drug effects</topic><topic>Body Weight</topic><topic>Cesarean Section - adverse effects</topic><topic>China</topic><topic>Dose-Response Relationship, Drug</topic><topic>Double-Blind Method</topic><topic>Drug Dosage Calculations</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - diagnosis</topic><topic>Hypotension - etiology</topic><topic>Hypotension - physiopathology</topic><topic>Hypotension - prevention & control</topic><topic>Infusions, Intravenous</topic><topic>Parturition</topic><topic>Phenylephrine - administration & dosage</topic><topic>Phenylephrine - adverse effects</topic><topic>Pregnancy</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vasoconstrictor Agents - administration & dosage</topic><topic>Vasoconstrictor Agents - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xiao, Fei</creatorcontrib><creatorcontrib>Shen, Bei</creatorcontrib><creatorcontrib>Xu, Wen-ping</creatorcontrib><creatorcontrib>Feng, Ying</creatorcontrib><creatorcontrib>Ngan Kee, Warwick D</creatorcontrib><creatorcontrib>Chen, Xin-zhong</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xiao, Fei</au><au>Shen, Bei</au><au>Xu, Wen-ping</au><au>Feng, Ying</au><au>Ngan Kee, Warwick D</au><au>Chen, Xin-zhong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2020-01</date><risdate>2020</risdate><volume>130</volume><issue>1</issue><spage>187</spage><epage>193</epage><pages>187-193</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><abstract>BACKGROUND:Prophylactic IV infusion of phenylephrine has been recommended to prevent hypotension during spinal anesthesia for cesarean delivery. However, the optimal infusion dose is unknown. This study aimed to determine the infusion dose of phenylephrine that would be effective in preventing hypotension in 50% (ED50) and 90% (ED90) of patients when administered as a prophylactic infusion at a fixed rate based on the individual body weight.
METHODS:Eighty parturients scheduled for elective cesarean delivery were randomly allocated to receive IV infusion of prophylactic phenylephrine at 0.25, 0.375, 0.5, or 0.625 µg/kg/min (n = 20 per group) started immediately after intrathecal injection of 10 mg hyperbaric bupivacaine and 5 µg sufentanil using a combined spinal–epidural technique. An effective dose was defined by the occurrence of no hypotension (defined as a decrease in systolic blood pressure by ≥20% below baseline and to <90 mm Hg) during the interval from the initiation of spinal anesthesia to delivery of the infant. Values for ED50 and ED90 of prophylactic phenylephrine were calculated using probit analysis.
RESULTS:Hypotension occurred in 13/20, 8/20, 2/20, and 1/20 patients in the groups that received phenylephrine infusion at 0.25, 0.375, 0.5, or 0.625 µg/kg/min, respectively. The calculated values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively. No difference was found in the incidence of adverse effects and neonatal outcomes among groups.
CONCLUSIONS:Under the conditions of this study, when phenylephrine was given as a fixed-rate prophylactic infusion during spinal anesthesia for cesarean delivery to prevent hypotension, the values for ED50 and ED90 were 0.31 (95% CI, 0.24–0.36) and 0.54 (95% CI, 0.46–0.76) µg/kg/min, respectively.</abstract><cop>United States</cop><pub>International Anesthesia Research Society</pub><pmid>30829668</pmid><doi>10.1213/ANE.0000000000004092</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adrenergic alpha-1 Receptor Agonists - administration & dosage Adrenergic alpha-1 Receptor Agonists - adverse effects Anesthesia, Epidural - adverse effects Anesthesia, Obstetrical Anesthesia, Spinal - adverse effects Blood Pressure - drug effects Body Weight Cesarean Section - adverse effects China Dose-Response Relationship, Drug Double-Blind Method Drug Dosage Calculations Female Humans Hypotension - diagnosis Hypotension - etiology Hypotension - physiopathology Hypotension - prevention & control Infusions, Intravenous Parturition Phenylephrine - administration & dosage Phenylephrine - adverse effects Pregnancy Time Factors Treatment Outcome Vasoconstrictor Agents - administration & dosage Vasoconstrictor Agents - adverse effects |
| title | Dose–Response Study of 4 Weight-Based Phenylephrine Infusion Regimens for Preventing Hypotension During Cesarean Delivery Under Combined Spinal–Epidural Anesthesia |
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