Intravenous initial bolus during prophylactic norepinephrine infusion to prevent spinal hypotension for cesarean delivery: A randomized controlled, dose-finding trial
Authors' conclusion
An initial bolus of 0.150 μg/kg of norepinephrine may be the optimal dose for preventing spinal hypotension during cesarean delivery with a continuous infusion rate of 0.05 μg/kg/min, and does not significantly increase the incidence of hypertension but substantially reduces the risk of nausea and/or vomiting.
Study context
- Population
- Parturients scheduled for elective cesarean delivery117 per-protocol
- Participants
- 120 participants
- Comparison
- Initial norepinephrine bolus 0, 0.05, 0.10 or 0.15 μg/kg followed by infusion 0.05 μg/kg/min
- Primary endpoint
- Dose-response relationship of initial norepinephrine bolus in preventing spinal hypotension (systolic blood pressure (SBP) <80% of baseline or <90 mmHg from intrathecal injection to delivery)
Methodological detailsdose-finding
- Dose-finding
Primary result
As reported in the abstract
Spinal hypotension
μg/kg
- ED90
- 0.150 (95% CI 0.114-0.241 μg/kg)
- ED95 (outside the dose range examined)
- 0.187 (95% CI 0.141-0.313 μg/kg)
Secondary outcomes
Severe spinal hypotension (SBP <60% of baseline) · differed significantly among groups
P = 0.02
Fetal outcomes
- Comparable among the groups
Safety
| Outcome | P value |
|---|---|
| Nausea and/or vomitingIncidence decreased with increasing bolus dose | P = 0.03 |
Hypertension and bradycardia
- Incidence did not differ significantly among groups
Original publication
Intravenous initial bolus during prophylactic norepinephrine infusion to prevent spinal hypotension for cesarean delivery: A randomized controlled, dose-finding trial. J Clin Anesth. Published 23 July 2024. doi:10.
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