Colloid Co-hydration and Vasoconstrictor Infusion for Prevention of Hypotension During Cesarean Section (annie-zoe)

Colloid Co-hydration and Vasoconstrictor Infusion for Prevention of Hypotension During Cesarean Section

Colloid Co-hydration and Vasoconstrictor Infusion for Prevention of Postspinal Hypotension During Elective Cesarean Section. A Comparative Study

This will be a double-blind randomized study, aiming at investigating a fixed rate phenylephrine infusion versus a fixed rate norepinephrine infusion versus placebo in combination with co-hydration with colloids for the prevention of maternal hypotension in elective cesarean section

Neuraxial techniques are the anesthetic techniques of choice in contemporary obstetric anesthesia practice, with a definitive superiority as compared to general anesthesia, since, by their use, serious complications involving the airway can be avoided.Spinal anesthesia has become the favorable technique for both elective and emergency cesarean section due to a quick and predictable onset of action, however, it can be frequently complicated by hypotension, with incidence exceeding 80% occasionally. The aim of the current randomized controlled double-blinded trial was to compare the effect of a fixed-rate norepinephrine infusion versus a fixed-rate phenylephrine infusion versus placebo in parturients subjected to elective cesarean section under combined spinal-epidural anesthesia. All parturients will also receive colloid co-hydration.

Hypotension Symptomatic, Vasoconstriction, Cesarean Section Complications, Obstetric Anesthesia Problems

in parturients allocated to the phenylephrine group, a phenylephrine infusion will be started as soon as spinal anesthesia is initiated

in parturients allocated to the norepinephrine group, a norepinephrine infusion will be started as soon as spinal anesthesia is initiated

in parturients allocated to the placebo group, a normal saline infusion will be started as soon as spinal anesthesia is initiated

any occurence of hypotension (systolic blood pressure<80% of baseline) throughout the operation will be recorded

any requirement for modification or cessation of the infusion due to reactive hypertension or bradycardia will be recorded

Neonatal Apgar score will be recorded at 1 minutes after delivery. The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. Scores 7 and above are generally normal; 4 to 6, fairly low; and 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts.

Neonatal Apgar score will be recorded at 5 minutes after delivery. The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10. Scores 7 and above are generally normal; 4 to 6, fairly low; and 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts.

an amount of the umbilical artery cord blood sampled from every neonate will be sent for lab measurements

an amount of the umbilical artery cord blood sampled from every neonate will be sent for lab measurements

Inclusion Criteria: adult parturients, American Society of Anesthesiologists (ASA) I-II, singleton gestation>37 weeks elective cesarean section Exclusion Criteria: Body Mass Index (BMI) >40 kg/m2 Body weight <50 kg Body weight>100 kg height<150 cm height>180 cm multiple gestation fetal abnormality fetal distress active labor cardiac disease pregnancy-induced hypertension thrombocytopenia coagulation abnormalities use of antihypertensive medication during pregnancy communication or language barriers lack of informed consent contraindication for regional anesthesia

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