Relative potency of norepinephrine and mephentermine bolus for the treatment of spinal hypotension during elective caesarean delivery – a randomized, blinded up-down sequential allocation study

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
M. Mohta, R. Kumar, R. Salhotra, S. Kumari, P. Mulodhia
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Abstract

Background

Vasopressors are the mainstay of management of spinal hypotension during caesarean delivery. Norepinephrine, an α- and β-adrenergic agonist, has a lower incidence of bradycardia and is an alternative to phenylephrine. Mephentermine is another such vasopressor and is used in many developing countries. Earlier studies compared norepinephrine and mephentermine using fixed or indirectly calculated doses. The purpose of the current study was to estimate their equipotent doses for the treatment of hypotension.

Methods

One hundred healthy parturients with term, uncomplicated, singleton pregnancy undergoing elective caesarean delivery, who developed spinal hypotension, were studied. Hypotension was defined as >20% fall from baseline systolic blood pressure and was treated with a blinded, predetermined dose of norepinephrine or mephentermine. The dose for each patient was determined according to the response in the previous patient using the Narayana rule for up-down sequential allocation. The ED95 and ED50 of norepinephrine and mephentermine boluses and their relative potency ratio were calculated.

Results

The ED95 was 7.2 µg (95% confidence interval [CI]: 4.9 to 9.5) for norepinephrine and 1.59 mg (95% CI: 1.43 to 1.75) for mephentermine. The ED50 values were 6.9 µg (95% CI: 6.2 to 7.7) and 1.39 mg (95% CI: 1.33 to 1.46), respectively. The relative ED95 and ED50 potency ratios of norepinephrine to mephentermine were 222 (95% CI: 201 to 242) and 201 (95% CI: 193 to 210), respectively.

Conclusion

When used as bolus for treatment of spinal hypotension during elective caesarean delivery, norepinephrine is approximately 220 times more potent than mephentermine; therefore, norepinephrine 8 μg is approximately equivalent to mephentermine 1.7 mg.
去甲肾上腺素和甲非特明丸治疗选择性剖宫产期间脊柱低血压的相对效力——一项随机、盲法自上而下顺序分配研究
背景:在剖宫产过程中,血压升高是治疗脊柱低血压的主要方法。去甲肾上腺素是一种α-和β-肾上腺素能激动剂,具有较低的心动过缓发生率,是苯肾上腺素的替代品。甲非特明是另一种血管加压药,在许多发展中国家使用。早期的研究比较了去甲肾上腺素和甲非明使用固定或间接计算剂量。本研究的目的是估计它们治疗低血压的等效剂量。方法对100例健康足月、无并发症、单胎妊娠发生脊柱低血压的孕妇进行择期剖宫产。低血压被定义为比基线收缩压下降20%,并采用盲法、预定剂量的去甲肾上腺素或甲苯二胺治疗。每位患者的剂量根据前一位患者的反应确定,采用Narayana规则进行上下顺序分配。计算去甲肾上腺素和苯丙胺丸的ED95和ED50及其相对效价比。结果去甲肾上腺素的ED95为7.2µg(95%可信区间[CI]: 4.9 ~ 9.5),甲非明的ED95为1.59 mg(95%可信区间[CI]: 1.43 ~ 1.75)。ED50值分别为6.9µg (95% CI: 6.2 ~ 7.7)和1.39 mg (95% CI: 1.33 ~ 1.46)。去甲肾上腺素与甲芬特明的相对ED95和ED50效价比分别为222 (95% CI: 201 ~ 242)和201 (95% CI: 193 ~ 210)。结论在选择性剖宫产术中,去甲肾上腺素作为丸剂治疗脊柱低血压时,其效价约为甲氧芬特明的220倍;因此,去甲肾上腺素8 μg大约相当于1.7 mg的甲氧芬特明。
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来源期刊
CiteScore
4.70
自引率
7.10%
发文量
285
审稿时长
58 days
期刊介绍: The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.
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