Epinephrine Infusion for Prophylaxis Against Maternal Hypotension During Caesarean Section
Status:
Not yet recruiting
Trial end date:
2021-12-01
Target enrollment:
Participant gender:
Summary
Maternal hypotension after spinal block is a common complication after subarachnoid block in
this population. The incidence of maternal hypotension is nearly 60% when prophylactic
vasopressors are not used. Therefore, it is highly recommended to use vasopressors,
preferably as continuous infusion, for prophylaxis rather than delaying their use until
hypotension occurs.
Phenylephrine (PE) is the recommended drug for prophylaxis against hypotension during
cesarean delivery; however, the use of PE is commonly associated with decreased heart rate
and probably cardiac output because PE is a pure alpha adrenoreceptor agonist . Introduction
of NE in obstetric practice had shown favorable maternal and neonatal outcomes and was
associated with higher heart rate and cardiac output compared to PE. However, there is still
some mothers who develop bradycardia and diminished cardiac output with the use of NE. The
most desired scenario during hemodynamic management of mothers during cesarean delivery would
achieve the least possible incidences of maternal hypotension, bradycardia and reactive
hypertension. Therefore, it is warranted to reach a vasopressor regimen with the most stable
hemodynamic profile.
In the last year, epinephrine was reported for the first time in obstetric practice with
acceptable safety on the mother and the fetus. However, there is still lack of data about the
most appropriate dose for infusion during cesarean delivery. In this study, we aim to compare
three prophylactic infusion rates for epinephrine during cesarean delivery.