Incidence of bradycardia during noradrenaline or phenylephrine bolus treatment of postspinal hypotension in cesarean delivery: A randomized double-blinded controlled trial

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dc.contributor.authorde Queiroz, Daniel Vieira
dc.contributor.authorVelarde, Luis Guillermo Coca
dc.contributor.authorAlves, Rodrigo Leal [UNESP]
dc.contributor.authorVerçosa, Nubia
dc.contributor.authorCavalcanti, Ismar Lima
dc.contributor.institutionServidores do Estado Federal Hospital (Hospital Federal dos Servidores do Estado)
dc.contributor.institutionUniversidade Federal Fluminense (UFF)
dc.contributor.institutionUniversidade Estadual Paulista (UNESP)
dc.contributor.institutionUniversidade Federal do Rio de Janeiro (UFRJ)
dc.date.accessioned2023-07-29T13:46:57Z
dc.date.available2023-07-29T13:46:57Z
dc.date.issued2023-01-01
dc.description.abstractThe treatment of choice for spinal anesthesia-induced hypotension during cesarean section is phenylephrine. As this vasopressor can cause reflex bradycardia, noradrenaline is a suggested alternative. This randomized double-blinded controlled trial included 76 parturients undergoing elective cesarean delivery under spinal anesthesia. Women received noradrenaline in bolus doses of 5 mcg or phenylephrine in bolus doses of 100 mcg. These drugs were used intermittently and therapeutically to maintain systolic blood pressure ≥ 90% of its baseline value. The primary study outcome was bradycardia incidence (<60 bpm) with intermittent bolus administration of these drugs. Secondary outcomes included extreme bradycardia (<40 bpm), number of bradycardia episodes, hypertension (systolic blood pressure > 120% of baseline value), and hypotension (systolic blood pressure < 90% of baseline value and requiring vasopressor use). Neonatal outcomes per the Apgar scale and umbilical cord blood gas analysis were also compared. The incidence of bradycardia in both groups (51.4% and 70.3%, respectively; p = 0.16) were not significantly different. No neonates had umbilical vein or artery pH values below 7.20. The noradrenaline group required more boluses than phenylephrine group (8 vs. 5; p = 0.01). There was no significant intergroup difference in any of the other secondary outcomes. When administered in intermittent bolus doses for the treatment of postspinal hypotension in elective cesarean delivery, noradrenaline, and phenylephrine have a similar incidence of bradycardia. When treating hypotension related to spinal anesthesia in obstetric cases, strong vasopressors are commonly administered, thought these can also have side effects. This trial assessed bradycardia after bolus administration of noradrenaline or phenylephrine, and found no difference in risk for clinically meaningful bradycardia.en
dc.description.affiliationDepartment of Anesthesiology Servidores do Estado Federal Hospital (Hospital Federal dos Servidores do Estado)
dc.description.affiliationMedical Sciences Postgraduate Program Fluminense Federal University (Universidade Federal Fluminense)
dc.description.affiliationDepartment of Statistics Medical Sciences Postgraduate Program Fluminense Federal University (Universidade Federal Fluminense)
dc.description.affiliationDepartment of Postgraduate Program in Anesthesiology Botucatu School of Medicine São Paulo State University (Universidade Estadual Paulista)
dc.description.affiliationDepartment of Surgery Anesthesiology Surgical Sciences Postgraduate Program Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro)
dc.description.affiliationDepartment of General and Specialized Surgery Anesthesiology Fluminense Federal University (Universidade Federal Fluminense)
dc.description.affiliationUnespDepartment of Postgraduate Program in Anesthesiology Botucatu School of Medicine São Paulo State University (Universidade Estadual Paulista)
dc.identifierhttp://dx.doi.org/10.1111/aas.14225
dc.identifier.citationActa Anaesthesiologica Scandinavica.
dc.identifier.doi10.1111/aas.14225
dc.identifier.issn1399-6576
dc.identifier.issn0001-5172
dc.identifier.scopus2-s2.0-85150609259
dc.identifier.urihttp://hdl.handle.net/11449/248547
dc.language.isoeng
dc.relation.ispartofActa Anaesthesiologica Scandinavica
dc.sourceScopus
dc.titleIncidence of bradycardia during noradrenaline or phenylephrine bolus treatment of postspinal hypotension in cesarean delivery: A randomized double-blinded controlled trialen
dc.typeArtigo
unesp.author.orcid0000-0002-3255-5129[1]

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