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Sponsored by: |
Northwestern University |
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Information provided by: | Northwestern University |
ClinicalTrials.gov Identifier: | NCT00458003 |
Hypotension remains a common clinical problem after induction of spinal anesthesia for cesarean delivery. Maternal hypotension has been associated with considerable morbidity (maternal nausea and vomiting and fetal/neonatal acidemia). Traditionally, ephedrine has been the vasopressor of choice because of concerns about phenylephrine's potential adverse effect on uterine blood flow. This practice was based on animal studies which showed that ephedrine maintained cardiac output and uterine blood flow, while direct acting vasocontrictors, e.g., phenylephrine, decreased uteroplacental perfusion. However, several recent studies have demonstrated that phenylephrine has similar efficacy to ephedrine for preventing and treating hypotension and may be associated with a lower incidence of fetal acidosis. All of these studies have been performed in healthy patients undergoing elective cesarean delivery. Preeclampsia complicates 5-6% of all pregnancies and is a significant contributor to maternal and fetal morbidity and mortality. Many preeclamptic patients require cesarean delivery of the infant. These patients often have uteroplacental insufficiency. Given the potential for significant hypotension after spinal anesthesia and its effect on an already compromised fetus, prevention of (relative) hypotension in preeclamptic patients is important.
Spinal anesthesia in preeclamptic patients has been shown to have no adverse neonatal outcomes as compared to epidural anesthesia when hypotension is treated adequately. Due to problems related to management of the difficult airway and coagulopathy, both of which are more common in preeclamptic women, spinal anesthesia may be the preferred regional anesthesia technique. Recent studies have demonstrated that preeclamptic patients may experience less hypotension after spinal anesthesia than their healthy counterparts. To our knowledge, phenylephrine for the treatment of spinal anesthesia-induced hypotension has not been studied in women with preeclampsia. The aim of our study is to compare intravenous infusion regimens of phenylephrine versus ephedrine for the treatment of spinal anesthesia induced hypotension in preeclamptic patients undergoing cesarean delivery. The primary outcome variable is umbilical artery pH.
Condition | Intervention |
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Preeclampsia Spinal Anesthesia Hypotension Cesarean Section |
Drug: Ephedrine Drug: Phenylephrine |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Active Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | Phenylephrine Versus Ephedrine to Treat Spinal Anesthesia-Induced Hypotension in Preeclamptic Patients During Cesarean Delivery |
Estimated Enrollment: | 100 |
Study Start Date: | July 2006 |
Estimated Study Completion Date: | December 2010 |
Estimated Primary Completion Date: | December 2010 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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Phenylephrine: Experimental
Subject will receive a phenylephrine infusion to prevent and treatment spinal anesthesia-associated hypotension
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Drug: Phenylephrine
Phenylephrine concentration: 100 mcg/mL. The infusion will be initiated immediately after completion of the spinal injection at a rate of 1 mL/min and continued for a minimum of 2 min after which the infusion will be stopped, continued or increased based on the SBP each minute. The goal will be to maintain SBP ≥ 80% baseline, but < 160 mmHg. After each SBP measurement the infusion will be stopped if SBP > 80% baseline, and the infusion will be continued or restarted if the SBP is approximately equal to 80% baseline. The infusion will be increased by 1 mL/min if the SBP < 80% baseline. Hypotension is defined as a decrease in SBP to < 80% of baseline. Each time there hypotension the patient will receive a 1 mL IV bolus of the study solution and the infusion will be increased by 1 mL/min. The infusion and bolus protocol will be continued until delivery. If the baseline SBP > 160 mmHg, the infusion will not be started until the SBP decreases to 160 mmHg. |
Ephedrine: Active Comparator
Subject will receive an ephedrine infusion to prevent and treatment spinal anesthesia-associated hypotension
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Drug: Ephedrine
Ephedrine concentration: 8 mg/mL. The infusion will be initiated immediately after completion of the spinal injection at a rate of 1 mL/min and continued for a minimum of 2 min after which the infusion will be stopped, continued or increased based on the SBP each minute. The goal will be to maintain SBP ≥ 80% baseline, but < 160 mmHg. After each SBP measurement the infusion will be stopped if SBP > 80% baseline, and the infusion will be continued or restarted if the SBP is approximately equal to 80% baseline. The infusion will be increased by 1 mL/min if the SBP < 80% baseline. Hypotension is defined as a decrease in SBP to < 80% of baseline. Each time there hypotension the patient will receive a 1 mL IV bolus of the study solution and the infusion will be increased by 1 mL/min. The infusion and bolus protocol will be continued until delivery. If the baseline SBP > 160 mmHg, the infusion will not be started until the SBP decreases to 160 mmHg. |
Ages Eligible for Study: | 18 Years to 60 Years |
Genders Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
United States, Illinois | |
Northwestern University | Recruiting |
Chicago, Illinois, United States, 60611 | |
Contact: Robert McCarthy, PharmD 312-926-9015 r-mccarthy@northwestern.edu | |
Principal Investigator: Cynthia A. Wong, M.D. | |
Northwestern Memorial Hospital | Recruiting |
Chicago, Illinois, United States, 60611 | |
Contact: Robert McCarthy, PharmD 312-926-9015 r-mccarthy@northwestern.edu | |
Principal Investigator: Cynthia A Wong, M.D. |
Principal Investigator: | Cynthia A. Wong, M.D. | Northwestern University |
Responsible Party: | Northwestern University ( Cynthia A. Wong, MD ) |
Study ID Numbers: | 0524-31 |
Study First Received: | April 4, 2007 |
Last Updated: | November 25, 2008 |
ClinicalTrials.gov Identifier: | NCT00458003 History of Changes |
Health Authority: | United States: Institutional Review Board |
Preeclampsia Spinal Anesthesia Hypotension |
Cesarean Delivery Phenylephrine Ephedrine |
Hypotension Neurotransmitter Agents Pregnancy Complications Adrenergic Agents Benzocaine Anesthetics Pre-Eclampsia Preeclampsia Adrenergic Agonists Nasal Decongestants Hypertension, Pregnancy-Induced Phenylephrine Vasoconstrictor Agents Pseudoephedrine |
Adrenergic alpha-Agonists Eclampsia Vascular Diseases Central Nervous System Depressants Anti-Asthmatic Agents Central Nervous System Stimulants Cardiovascular Agents Oxymetazoline Mydriatics Ephedrine Peripheral Nervous System Agents Bronchodilator Agents Hypertension |
Hypotension Respiratory System Agents Neurotransmitter Agents Pregnancy Complications Adrenergic Agents Molecular Mechanisms of Pharmacological Action Cardiotonic Agents Physiological Effects of Drugs Anesthetics Pre-Eclampsia Adrenergic Agonists Nasal Decongestants Hypertension, Pregnancy-Induced Phenylephrine Therapeutic Uses |
Vasoconstrictor Agents Cardiovascular Diseases Pseudoephedrine Adrenergic alpha-Agonists Sympathomimetics Vascular Diseases Anti-Asthmatic Agents Central Nervous System Depressants Central Nervous System Stimulants Cardiovascular Agents Protective Agents Pharmacologic Actions Oxymetazoline Mydriatics Autonomic Agents |