Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section

Mohta, Medha; Dubey, Mamta; Malhotra, Rajeev; Tyagi, Asha

doi:10.1016/j.ijoa.2018.12.002

Cited by 47 publications

(56 citation statements)

References 13 publications

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“…In a recent dose-response study, which was not available when we started recruiting our patients, Mohta et al found that the ED95 for NE bolus was 3.7 mcg which is lower than our doses [11]. However, Mohta et al had a different experimental design compared to ours.…”

Section: Discussioncontrasting

confidence: 55%

“…Onwochei et al [9] had reported a 95% effective dose (ED95) of 5.8 mcg. Ngan Kee [10] had reported a 50% effective dose (ED50) of 10 mcg, and Mohta et al had found that ED95 for NE bolus was 3.7 mcg [11]. Our study had a different design from the previous work as it aimed to manage hypotension in mothers who were already receiving prophylactic NE infusion.…”

Section: Discussionmentioning

confidence: 94%

“…However, Mohta et al had a different experimental design compared to ours. Mohta et al [11] recruited 50 mothers and started with a 6 mcg bolus, then performed an incremental reduction of the dose. Thus, only one mother among their participants received 6 mcg, 5.5 mcg, 5 mcg, or 4.5 mcg bolus doses each.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

Hassabelnaby¹,

Hasanin²,

Adly³

et al. 2020

BMC Anesthesiol

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Background: Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery. Methods: This randomized, controlled trial included mothers scheduled for cesarean delivery with spinal anesthesia with a prophylactic norepinephrine infusion. Following spinal anaesthesia administration, a participant was considered hypotensive if systolic blood pressure was ≤80% compared to the baseline reading. Participants were allocated to receive either 6 mcg or 10 mcg norepinephrine bolus for the management of hypotensive episodes. The hemodynamic response after administration of norepinephrine bolus was recorded. The episode was considered successfully managed if systolic blood pressure returned to within 80% from the baseline reading within 2 min after norepinephrine bolus administration, and did not drop again within 6 min after the norepinephrine bolus. The primary outcome was the incidence of successful management of the first hypotensive episode. Other outcomes included systolic blood pressure, heart rate, incidence of maternal bradycardia, and reactive hypertension. Results: One hundred and ten mothers developed hypotensive episodes and received norepinephrine boluses for management. The number of successfully managed first hypotensive episodes was 50/57 (88%) in the 6 mcgtreated episodes and 45/53 (85%) in the 10 mcg-treated episodes (p = 0.78). Systolic blood pressure was comparable after administration of either bolus dose. Heart rate was lower after administration of 10 mcg bolus compared to 6 mcg bolus, without significant bradycardia requiring atropine administration. The incidence of reactive hypertension was comparable between both groups.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 94%

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Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

Hassabelnaby¹,

Hasanin²,

Adly³

et al. 2020

BMC Anesthesiol

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“…Alternatively, as calculated by Mohta et al. themselves in another study it was 11.3:1 . Therefore, noradrenaline 5 μg is almost certainly less potent than phenylephrine 100 μg.…”

mentioning

confidence: 92%

An alternative explanation for the inferior neonatal outcome with noradrenaline?

Wang

Shen

2019

Anaesthesia

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“…We fully agree that noradrenaline 5 μg is less potent than phenylephrine 100 μg. Two studies which calculated the potency ratio of noradrenaline and phenylephrine , assessed response to only a single dose of either of the two vasopressors to treat a first episode of hypotension. The fact that the drug requirements to treat further episodes of hypotension could not be studied was included as a limitation in both these studies.…”

mentioning

confidence: 99%

An alternative explanation for the inferior neonatal outcome with noradrenaline? A reply

et al. 2019

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Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section

Cited by 47 publications

References 13 publications

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

An alternative explanation for the inferior neonatal outcome with noradrenaline?

An alternative explanation for the inferior neonatal outcome with noradrenaline? A reply

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