International journal of obstetric anesthesia · 2024
Comparison of mephentermine and norepinephrine infusions for prevention of post-spinal hypotension during elective caesarean delivery: a randomised, double-blind trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mohta M, Kumari N, Chilkoti G T, Agarwal D, Malhotra R K, Agarwal R
Аннотация
BACKGROUND: Vasopressors having α-agonist and some β-agonist activity are thought to maintain heart rate better than pure α-agonist agents when used for prevention and treatment of post-spinal hypotension during caesarean delivery. Norepinephrine and mephentermine are two such agents. They have been compared by some network meta-analyses; however, no direct comparative studies of prophylactic infusions of these two vasopressors are available in literature.
METHODS: Sixty mothers with term, uncomplicated, singleton pregnancy undergoing elective caesarean delivery under spinal anaesthesia received either mephentermine (600 μg/min) or norepinephrine (4 μg/min) infusion initially for prophylaxis of post-spinal hypotension. The infusion rate was titrated to maintain systolic blood pressure near baseline. The primary outcome measure was umbilical artery pH; the secondary outcome measures included Apgar scores, incidence of fetal acidosis (umbilical artery pH <7.2), and maternal hypotension, hypertension, bradycardia, tachycardia, maternal complications. Data presented as mean ± standard deviation.
RESULTS: Mean umbilical artery pH was significantly higher in mephentermine group than in norepinephrine group (7.275 ± 0.061 vs. 7.244 ± 0.049; P=0.039). Umbilical artery and venous base excess and venous pH were also significantly higher in mephentermine group. Secondary outcomes did not differ between the groups. Mephentermine group required a significantly higher total infusion volume than norepinephrine group (16.3 ± 5.8 mL vs. 12.9 ± 6.7 mL; P=0.045).
CONCLUSION: Prophylactic titrated infusions of both mephentermine and norepinephrine maintained good fetal blood gases during elective caesarean delivery, but mephentermine demonstrated superiority over norepinephrine in this respect. However, higher volumes of mephentermine infusion were required to maintain maternal systolic blood pressure near baseline values. Therefore, further studies are required to determine the equipotent doses of these two vasopressors.
METHODS: Sixty mothers with term, uncomplicated, singleton pregnancy undergoing elective caesarean delivery under spinal anaesthesia received either mephentermine (600 μg/min) or norepinephrine (4 μg/min) infusion initially for prophylaxis of post-spinal hypotension. The infusion rate was titrated to maintain systolic blood pressure near baseline. The primary outcome measure was umbilical artery pH; the secondary outcome measures included Apgar scores, incidence of fetal acidosis (umbilical artery pH <7.2), and maternal hypotension, hypertension, bradycardia, tachycardia, maternal complications. Data presented as mean ± standard deviation.
RESULTS: Mean umbilical artery pH was significantly higher in mephentermine group than in norepinephrine group (7.275 ± 0.061 vs. 7.244 ± 0.049; P=0.039). Umbilical artery and venous base excess and venous pH were also significantly higher in mephentermine group. Secondary outcomes did not differ between the groups. Mephentermine group required a significantly higher total infusion volume than norepinephrine group (16.3 ± 5.8 mL vs. 12.9 ± 6.7 mL; P=0.045).
CONCLUSION: Prophylactic titrated infusions of both mephentermine and norepinephrine maintained good fetal blood gases during elective caesarean delivery, but mephentermine demonstrated superiority over norepinephrine in this respect. However, higher volumes of mephentermine infusion were required to maintain maternal systolic blood pressure near baseline values. Therefore, further studies are required to determine the equipotent doses of these two vasopressors.