JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2020, Vol. 40 ›› Issue (11): 1495-1499.doi: 10.3969/j.issn.1674-8115.2020.11.010

• Original article (Clinical research) • Previous Articles     Next Articles

A clinical research of ED90 norepinephrine to prevent hypotension after combined spinal and epidural anesthesia during cesarean delivery

SHEN Ting, XU Tao, ZHENG Jing, AN Xiao-hu, XU Zi-feng, CHAI Jing   

  1. Department of Anesthesiology, the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
  • Online:2020-11-28 Published:2021-01-13
  • Supported by:
    Project of Shanghai Municipal Key Clinical Specialty-Gynecological and Obstetrical Item; Clinical Science and Technology Innovation Program from Shanghai Hospital Development Center (SHDC12016225).

Abstract: Objective · To determine the optimal intravenous norepinephrine bolus dose needed to prevent hypotension after combined spinal and epidural anesthesia in 90% of women during elective cesarean delivery. Methods · Forty women undergoing elective cesarean delivery were allocated into this double-blinded, prospective, and sequential dose-finding study using biased coin design sequential method. The primary outcome was the successful use of the norepinephrine bolus dose to maintain systolic blood pressure above 80% of the baseline until delivery. Secondary outcomes included dizziness, breathlessness, nausea, vomiting, bradycardia, secondary hypertension and supplemental use of atropine or norepinephrine of the women, as well as 1 min and 5 min Apgar scores of the newborns. The 90% effective dose (ED90) and its 95%CI were estimated using Isotonic regression methods. Results · The estimated ED90 intravenous bolus dose of norepinephrine was [10.85 (95%CI 9.20-11.67)] μg to prevent hypotension after combined spinal and epidural anesthesia during cesarean delivery. The occurrence rates of dizziness, breathlessness, and nausea were 2.5%, 7.5% and 10.0%, respectively. The occurrence rate of additional rescue norepinephrine boluses was 5.0%. No vomiting, bradycardia, secondary hypertension and supplemental use of atropine appeared. Apgar scores of all newborns at 1 min and 5 min were 10. Conclusion · An intravenous norepinephrine bolus dose of 11 μg is recommended to prevent hypotension after combined spinal and epidural anesthesia during cesarean delivery for clinical practice.

Key words: norepinephrine, 90% effective dose (ED90), hypotension, combined spinal and epidural anesthesia, cesarean delivery

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