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A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery

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dc.contributor.author Siddik-Sayyid S.M.
dc.contributor.author Taha S.K.
dc.contributor.author Kanazi G.E.
dc.contributor.author Aouad M.T.
dc.contributor.editor
dc.date Mar-2014
dc.date.accessioned 2017-10-05T15:29:15Z
dc.date.available 2017-10-05T15:29:15Z
dc.date.issued 2014
dc.identifier 10.1213/01.ane.0000437731.60260.ce
dc.identifier.isbn
dc.identifier.issn 00032999
dc.identifier.uri http://hdl.handle.net/10938/15169
dc.description.abstract BACKGROUND:: Phenylephrine infusion is used to reduce hypotension during spinal anesthesia for cesarean delivery. A prophylactic fixed rate infusion regimen may not improve hemodynamic control; a variable rate regimen adjusted in response to changes in arterial blood pressure and heart rate may allow more accurate maintenance of baseline blood pressure. We hypothesized that a combination of crystalloid solution coload with a variable rate phenylephrine infusion and phenylephrine rescue boluses may be associated with fewer physician interventions needed to maintain maternal systolic blood pressure within 20percent of baseline and greater hemodynamic stability than crystalloid solution coload with phenylephrine rescue boluses alone. METHODS:: In this prospective, double-blind study, 80 patients received a coload with 15 mL-kg lactated Ringer's solution immediately after the initiation of spinal anesthesia. Patients were randomized to receive a prophylactic variable rate phenylephrine infusion starting at 0.75 μg-kg-min (group P) or infusion of normal saline (group S). Maternal systolic blood pressure was maintained within 20percent of baseline with rescue phenylephrine boluses using a preset algorithm. During the predelivery period, the number of physician interventions (primary outcome), hemodynamic performance, nausea-vomiting, and umbilical cord blood gas values were compared between the groups. RESULTS:: One patient from group S was excluded due to protocol violation. Therefore, group P included 40 patients and group S 39 patients. The median (range) number of physician interventions needed to maintain maternal hemodynamics within the target range (0 [0-6] vs 3 [0-9], difference in median: 3, 95percent confidence interval of difference: 2-4) and incidence of hypotension (8-40 [20percent] vs 35-39 [90percent]) were lower in group P compared with group S (P 0.001). Group P had a higher incidence of hypertension compared with group S (6-40 [15percent] vs 0-39 [0percent], P = 0.026). The median performance error was closer to baseline (P 0.001) with a smaller median absolute performance error (P = 0.001) in group P versus group S. In group P, 4-40 (10percent) patients had nausea-vomiting compared with 17-39 (44percent) in group S (P = 0.001). The number needed to treat was 1.4 women to prevent 1 case of hypotension, and 3 women to prevent 1 case of nausea-vomiting; the rate of hypertension was 1 case per 6.7 women treated. Neonatal outcomes were not different between the 2 groups. CONCLUSION:: Prophylactic variable rate phenylephrine infusion and rescue phenylephrine bolus dosing is more effective than relying on rescue phenylephrine bolus dosing with respect to limiting clinician workload and maternal symptoms during spinal anesthesia for cesarean delivery. © 2013 International Anesthesia Research Society.
dc.format.extent
dc.format.extent Pages: (611-618)
dc.language English
dc.publisher PHILADELPHIA
dc.relation.ispartof Publication Name: Anesthesia and Analgesia; Publication Year: 2014; Volume: 118; no. 3; Pages: (611-618);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title A randomized controlled trial of variable rate phenylephrine infusion with rescue phenylephrine boluses versus rescue boluses alone on physician interventions during spinal anesthesia for elective cesarean delivery
dc.type Article
dc.contributor.affiliation Siddik-Sayyid, S.M., Department of Anesthesiology, American University, Beirut-Medical Center, P. O. Box 11, Beirut 0236, Lebanon
dc.contributor.affiliation Taha, S.K., Department of Anesthesiology, American University, Beirut-Medical Center, P. O. Box 11, Beirut 0236, Lebanon
dc.contributor.affiliation Kanazi, G.E., Department of Anesthesiology, American University, Beirut-Medical Center, P. O. Box 11, Beirut 0236, Lebanon
dc.contributor.affiliation Aouad, M.T., Department of Anesthesiology, American University, Beirut-Medical Center, P. O. Box 11, Beirut 0236, Lebanon
dc.contributor.authorAddress Aouad, M.T.; Department of Anesthesiology, American University, Beirut-Medical Center, P. O. Box 11, Beirut 0236, Lebanon; email: mm01@aub.edu.lb
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Anesthesiology;
dc.contributor.authorDepartment Anesthesiology
dc.contributor.authorDivision
dc.contributor.authorEmail mm01@aub.edu.lb
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Siddik-Sayyid, SM
dc.contributor.authorInitials Taha, SK
dc.contributor.authorInitials Kanazi, GE
dc.contributor.authorInitials Aouad, MT
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Aouad, MT (reprint author), Amer Univ Beirut Med Ctr, Dept Anesthesiol, POB 11-0236, Beirut, Lebanon.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.cited Allen TK, 2010, ANESTH ANALG, V111, P1221, DOI 10.1213-ANE.0b013e3181e1db21; Bonett DG, 2002, PSYCHOL METHODS, V7, P370, DOI 10.1037--1082-989X.7.3.370; Cooper D, 2012, INT J OBSTET ANESTH, V21, P245, DOI 10.1016-j.ijoa.2012.02.009; Cooper DW, 2012, CURR OPIN ANESTHESIO, V25, P300, DOI 10.1097-ACO.0b013e3283530d62; Doherty A, 2012, ANESTH ANALG, V115, P1343, DOI 10.1213-ANE.0b013e31826ac3db; Dyer RA, 2009, ANESTHESIOLOGY, V111, P753, DOI 10.1097-ALN.0b013e3181b437e0; JAMES FM, 1970, ANESTHESIOLOGY, V33, P25, DOI 10.1097-00000542-197007000-00010; Kee WDN, 2005, ANESTHESIOLOGY, V103, P744, DOI 10.1097-00000542-200510000-00012; Kee WDN, 2008, ANESTH ANALG, V107, P1295, DOI 10.1213-ane.0b013e31818065bc; Kee WDN, 2009, ANESTHESIOLOGY, V111, P506; Kee WDN, 2004, BRIT J ANAESTH, V92, P469, DOI 10.1093-bja-aeh088; Kee WDN, 2004, ANESTH ANALG, V98, P815; Kee WDN, 2013, BRIT J ANAESTH, V110, P59, DOI 10.1093-bja-aes339; RALSTON DH, 1974, ANESTHESIOLOGY, V40, P354, DOI 10.1097-00000542-197404000-00009; Stewart A, 2010, ANESTH ANALG, V111, P1230, DOI 10.1213-ANE.0b013e3181f2eae1; Veeser M, 2012, ACTA ANAESTH SCAND, V56, P810, DOI 10.1111-j.1399-6576.2011.02646.x
dc.description.citedCount 1
dc.description.citedTotWOSCount 3
dc.description.citedWOSCount 3
dc.format.extentCount 8
dc.identifier.articleNo
dc.identifier.coden AACRA
dc.identifier.pubmedID 24299932
dc.identifier.scopusID 84896738096
dc.identifier.url
dc.publisher.address 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA
dc.relation.ispartofConference
dc.relation.ispartofConferenceCode
dc.relation.ispartofConferenceDate
dc.relation.ispartofConferenceHosting
dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
dc.relation.ispartofFundingAgency
dc.relation.ispartOfISOAbbr Anesth. Analg.
dc.relation.ispartOfIssue 3
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle Anesthesia and Analgesia
dc.relation.ispartofPubTitleAbbr Anesth. Analg.
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 118
dc.source.ID WOS:000335396200020
dc.type.publication Journal
dc.subject.otherAuthKeyword
dc.subject.otherChemCAS Ringer lactate solution, 8022-63-7
dc.subject.otherChemCAS phenylephrine, 532-38-7, 59-42-7, 61-76-7
dc.subject.otherIndex phenylephrine
dc.subject.otherIndex Ringer lactate solution
dc.subject.otherIndex adult
dc.subject.otherIndex anesthesia complication
dc.subject.otherIndex article
dc.subject.otherIndex blood gas analysis
dc.subject.otherIndex bolus injection
dc.subject.otherIndex bradycardia
dc.subject.otherIndex cesarean section
dc.subject.otherIndex clinical article
dc.subject.otherIndex controlled study
dc.subject.otherIndex crystalloid
dc.subject.otherIndex diabetes mellitus
dc.subject.otherIndex double blind procedure
dc.subject.otherIndex drug dose comparison
dc.subject.otherIndex elective surgery
dc.subject.otherIndex female
dc.subject.otherIndex hemodynamics
dc.subject.otherIndex human
dc.subject.otherIndex hypertension
dc.subject.otherIndex hypotension
dc.subject.otherIndex infusion rate
dc.subject.otherIndex nausea and vomiting
dc.subject.otherIndex outcome assessment
dc.subject.otherIndex priority journal
dc.subject.otherIndex prospective study
dc.subject.otherIndex randomized controlled trial
dc.subject.otherIndex spinal anesthesia
dc.subject.otherIndex systolic blood pressure
dc.subject.otherIndex umbilical cord blood
dc.subject.otherIndex Adult
dc.subject.otherIndex Anesthesia, Spinal
dc.subject.otherIndex Cesarean Section
dc.subject.otherIndex Double-Blind Method
dc.subject.otherIndex Drug Administration Schedule
dc.subject.otherIndex Female
dc.subject.otherIndex Hemodynamics
dc.subject.otherIndex Humans
dc.subject.otherIndex Infusions, Intravenous
dc.subject.otherIndex Phenylephrine
dc.subject.otherIndex Physician's Role
dc.subject.otherIndex Pregnancy
dc.subject.otherIndex Prospective Studies
dc.subject.otherIndex Surgical Procedures, Elective
dc.subject.otherIndex Treatment Outcome
dc.subject.otherIndex Vasoconstrictor Agents
dc.subject.otherKeywordPlus ARTERIAL-PRESSURE
dc.subject.otherKeywordPlus BLOOD-PRESSURE
dc.subject.otherKeywordPlus DOUBLE-BLIND
dc.subject.otherKeywordPlus HYPOTENSION
dc.subject.otherKeywordPlus EPHEDRINE
dc.subject.otherKeywordPlus REGIMENS
dc.subject.otherKeywordPlus MANAGEMENT
dc.subject.otherKeywordPlus SECTION
dc.subject.otherWOS Anesthesiology


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