Key result
Norepinephrine administered by continuous infusion during spinal anesthesia for cesarean delivery maintained a higher cardiac index (90-100% of baseline) than phenylephrine (81-88%) (P=0.001).
Why the study?
Phenylephrine is recommended to counteract vasoplegia during cesarean delivery under spinal anesthesia, but norepinephrine might offer superior preservation of cardiac output.
Does norepinephrine improve cardiac index compared to phenylephrine in parturients undergoing elective cesarean delivery under spinal anesthesia?
Population
124 parturients scheduled for elective cesarean delivery under spinal anesthesia in a French tertiary maternity
Comparison
Continuous infusion of norepinephrine vs phenylephrine
Design
Pragmatic, parallel-group, double-blind randomized controlled trial
Authors
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Norepinephrine infusion better preserves cardiac output and BP stability than phenylephrine in cesarean spinal anesthesia; extends RCT support for its preferential use.
RCT (n=124)
Double-blind
parallel-group
No
Does norepinephrine improve cardiac index compared to phenylephrine in parturients undergoing elective cesarean delivery under spinal anesthesia?
p-value: p=.001
Norepinephrine continuous infusion during spinal anesthesia for cesarean delivery better preserves maternal cardiac index compared to phenylephrine, with both effectively maintaining blood pressure.
Belin et al. (2022) conducted an RCT in Elective cesarean delivery under spinal anesthesia (n=124). Norepinephrine vs. Phenylephrine (starting rate of 0.5 μg·kg -1 ·min -1) was evaluated on Change in cardiac index (CI) measured by thoracic bioreactance from SA to umbilical cord clamping (p=.001). Norepinephrine administered by continuous infusion during spinal anesthesia for cesarean delivery maintained a higher cardiac index (90-100% of baseline) than phenylephrine (81-88%) (P=0.001).
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