Drug Design, Development and Therapy (Sep 2022)
Effect of Weight-Adjusted Phenylephrine, Norepinephrine, and Metaraminol for Elective Cesarean Delivery on Neonatal Acid–Base Status: A Randomized Controlled Trial
Abstract
Tianyu Liu,1,* Zhiyong Cheng,2,* Shiya Zou,3,* Chao Xu,4 Shoudong Pan,3 Huabei Zeng,2 Yidong Shan,2 Yi Feng,1 Hong Zhang1 1Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Anesthesiology, Suqian Maternity Hospital, Suqian, Jangsu, People’s Republic of China; 3Department of Anesthesiology, Capital Institute of Pediatrics Affiliated Children’s Hospital, Beijing, People’s Republic of China; 4Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi Feng; Hong Zhang, Department of Anesthesiology, Peking University People’s Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, People’s Republic of China, Tel +86-13601083503 ; +86-13311281808, Email [email protected]; [email protected]: Many previous trials have compared the effects of different vasoactive drugs on cesarean section patients, but their infusion rate is based on experience rather than high-quality evidence. It is difficult to judge whether the effect of vasoactive drug comes from the better choice or a more appropriate at rates of vasoactive drugs. The effect of vasoactive drugs at the rates of the 90% effective dose needs to be verified and compared.Patients and Methods: Women undergoing elective caesarean delivery under combined spinal-epidural anaesthesia were randomized to receive phenylephrine or norepinephrine or metaraminol infusion at the rate that was assumed to be the 90% effective dose. Anesthetic management was standardized and included fluid loading with 10 mL/kg of Ringer. The primary outcome was the umbilical artery pH.Results: 78 patients were included. The umbilical artery pH was not significantly different among the three groups (phenylephrine group: 7.33 ± 0.03 vs norepinephrine group: 7.33 ± 0.04 vs metaraminol group: 7.33 ± 0.04, P = 0.99). There were no significant differences in the incidence of hypotension, hypertension, bradycardia, and nausea and vomiting among the three groups. The SBP of the phenylephrine group was significantly higher than that of the metaraminol group (adjustive P value = 0.005).Conclusion: Phenylephrine (0.54 μg/kg/min) or metaraminol (2 μg/kg/min) or norepinephrine (0.08 μg/kg/min) administered to healthy patients with elective cesarean section after spinal anesthesia has no significant effect on the acid-base balance of the fetus.Keywords: cesarean section, vasoactive drugs, foetal acid-base balance, randomized controlled trial
