Research letter: ED90 of phenylephrine prophylactic bolus dose to prevent maternal hypotension during cesarean delivery

Zheng, Jing; An, Xiaohu; Qian, Jie-Yan; Mai, Yujiao; Xu, Zifeng; Xu, Tao

doi:10.1016/j.jclinane.2020.109812

Cited by 2 publications

(4 citation statements)

References 5 publications

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“…Several methods have been proposed to reduce the incidence or severity of maternal hypotension after spinal anaesthesia during caesarean delivery, including the use intrathecal adjuvant opioids to decrease the total dose of local anaesthetics used [ 8 ], prophylactic use of vasopressors [ 4 , 9 ], and IV pre-load colloid liquid administration [ 10 ]. Zieleskiewicz et al [ 1 ] and Yao et al [ 3 ] used B ultrasound, Xu et al [ 20 ] and Toyama et al used [ 21 ] perfusion index of peripheral vessels to predict the risk of hypotension to enable early and individualised interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, hypotension prevention is paramount to good outcomes. Methods such as intrathecal adjuvant opioid use to reduce the total dose of anaesthetics delivered [ 8 ], prophylactic use of vasopressors [ 4 , 9 ], and the use of intravenous (IV) pre-load colloid liquid [ 10 ] have been proposed to reduce the incidence or extent of maternal hypotension after spinal anaesthesia during caesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

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Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study

Zhang

Wang

et al. 2021

BMC Pregnancy Childbirth

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Background Maternal hypotension after spinal anaesthesia occurs at a high rate during caesarean delivery and can lead to adverse maternal or foetal outcomes. The aim of this study was to determine the optimal dose of spinal ropivacaine for caesarean section with or without intravenous single bolus of S-ketamine and to observe the rates of hypotension associated with both methods. Methods Eighty women undergoing elective caesarean delivery were randomly allocated into either a ropivacaine only or ropivacaine with intravenous S-ketamine group. If the upper sensory level of the patient reached T6 and the visual analogue scale (VAS) scores remained below 3 points before delivery, the next patient had a 1/9th chance of receiving a lower dose or an 8/9th chance of receiving the same dose as the previous patient. If the patient had VAS scores of more than 2 points or needed an extra epidural rescue bolus before delivery, a higher dose was used for the next patient. The primary outcome was the successful use of spinal ropivacaine to maintain patient VAS score of < 3 points before delivery and the incidence of post-spinal hypotension in both groups. Secondary outcomes included the rates of hypotension-related symptoms and interventions, upper sensory level of anaesthesia, level of sedation, neonatal outcomes, Edinburgh Postnatal Depression Scale scores at admission and discharge, and post-operative analgesic effect. The 90% effective dose (ED90) and 95% confidence interval (95% CI) were estimated by isotonic regression. Results The estimated ED90 of ropivacaine was 11.8 mg (95% CI: 11.7–12.7) with and 14.7 mg (95% CI: 14.6–16.0) without intravenous S-ketamine, using biased coin up-down sequential dose-finding method. The rates of hypotension and associated symptoms were significantly lower in S-ketamine group than in the ropivacaine only group. Conclusions A spinal dose of ropivacaine 12 mg with a single intravenous 0.15 mg/kg bolus dose of S-ketamine may significantly reduce the risk of hypotension and induce sedation before delivery. This method may be used with appropriate caution for women undergoing elective caesarean delivery and at a high risk of hypotension or experiencing extreme nervousness. Trial registration http://www.chictr.org.cn (ChiCTR2000040375; 28/11/2020).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study

Zhang

Wang

et al. 2021

BMC Pregnancy Childbirth

Self Cite

View full text Add to dashboard Cite

show abstract

“…Several methods have been proposed to reduce the incidence or severity of maternal hypotension after spinal anesthesia during cesarean delivery, including the use intrathecal adjuvant opioids to decrease the total dose of anaesthetics used, 8 prophylactic use of vasopressors, 4,9 and IV pre-load colloid liquid administration. 10 Zieleskiewicz et al 1 and Yao et al 3 used B ultrasound, Xu et al 20 and Toyama et al…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Thus, hypotension prevention is paramount to good outcomes. Methods such as intrathecal adjuvant opioid use to reduce the total dose of anaesthetics delivered, 8 prophylactic use of vasopressors, 4,9 and the use of intravenous (IV) pre-load colloid liquid 10 have been proposed to reduce the incidence or extent of maternal hypotension after spinal anesthesia during cesarean delivery. S-ketamine is an S + isomer of ketamine that is twice as potent as ketamine 11 ; it achieves sedation, analgesia, and sympathetic activation 12 with a relatively low risk of side effects to mothers or infants, 13 making it an optimum choice as an IV adjuvant for spinal anesthesia during cesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

Optimum Dose of Spinal Ropivacaine with or Without Single Intravenous Bolus of S-Ketamine During Elective Cesarean Delivery: A Randomized, Sequential Dose-Finding Study

Zhang

Wang

et al. 2021

Preprint

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Background Post-spinal hypotension has a high occurrence during cesarean delivery, and can lead to adverse maternal or fetal outcomes. The purpose of the study was to determine the optimal dose of spinal ropivacaine for cesarean section with or without intravenous single bolus of S-ketamine and to observe the incidences of hypotension of both methods. Methods Eighty women undergoing elective cesarean delivery were randomly allocated into Group ropivacaine or Group ropivacaine with intravenous S-ketamine. If the upper sensory level of the patient reached T6 and the visual analogue scale (VAS) scores continuously below 3 before delivery, the next patient had a 1/9th chance of receiving a lower dose or an 8/9th chance of receiving the same of previous dose. If the patient had VAS scores above 2 or needed an extra epidural rescue bolus before delivery, a higher dose was used for the next patient. The primary outcome was the successful use of spinal ropivacaine to maintain VAS of patients below 3 before delivery and the incidence of post-spinal hypotension of both groups. Secondary outcomes included the incidences of hypotension related symptoms and managements, upper sensory level of anesthesia, level of sedation, neonatal outcomes, Edinburgh postnatal depression scale scores on admission and discharging of hospital and post-operative analgesic effect. The 90% effective dose (ED90) and 95% confidence interval (95% CI) were estimated by isotonic regression. Results The estimated ED90 of ropivacaine was 11.8 mg (95% CI 11.7–12.7) with and 14.7 mg (95% CI 14.6–16.0) without intravenous S-ketamine using biased coin up-down sequential dose-finding method, and the incidences of hypotension and its related symptoms were significantly lower in S-ketamine group. Conclusions A spinal dose of ropivacaine 12 mg with single intravenous 0.15 mg/kg bolus dose of S-ketamine may significantly reduce the risk of hypotension and provide sedative status before delivery, thus the method could be cautiously used in parturients with high risks of hypotension or extreme nervousness. Clinical trial registration: http://www.chictr.org.cn (ChiCTR2000040375; 28 Nov 2020)

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Research letter: ED90 of phenylephrine prophylactic bolus dose to prevent maternal hypotension during cesarean delivery

Cited by 2 publications

References 5 publications

Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study

Optimum dose of spinal ropivacaine with or without single intravenous bolus of S-ketamine during elective cesarean delivery: a randomized, double-blind, sequential dose-finding study

Optimum Dose of Spinal Ropivacaine with or Without Single Intravenous Bolus of S-Ketamine During Elective Cesarean Delivery: A Randomized, Sequential Dose-Finding Study

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