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      Comparative Dose-Response Study of Phenylephrine Bolus for the Treatment of the First Episode of Spinal Anesthesia-Induced Hypotension for Cesarean Delivery in Severe Preeclamptic versus Normotensive Parturients


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          It is well-known that severe preeclamptic parturients have less vasopressor requirements than normotensive parturients; however, the exact dose difference is poorly documented. This study aimed to determine and compare the ED 50 and ED 90 of a single bolus phenylephrine for the treatment of spinal anesthesia-induced hypotension in parturients with severe preeclampsia and parturients with normotension.


          Seventy-five parturients with severe preeclampsia scheduled for cesarean delivery under combined spinal-epidural anesthesia were enrolled and randomly allocated to receive a single bolus of phenylephrine at five different doses (40, 50, 60, 70, and 80 μg), whereas 75 parturients with normotension were randomized to receive a single bolus of phenylephrine at five different doses (70, 80, 90, 100, and 110 μg) for the treatment of the first episode of hypotension. Phenylephrine dose values were log-transformed, the proportions of the successful interventions at each dose were converted to probits, and regression analysis was performed.


          The ED 50 and ED 90 (95% CI) of bolus phenylephrine were 72.1 (61.7 to 79.9) μg and 107 (95.9–128.6) μg in parturients with normotension. The ED 50 and ED 90 values in parturients with severe preeclampsia were 47.6 (41.3–52.7) μg and 70.7 (62.9–86.7) μg. The relative median potency was 1.51 (1.16–2.61).


          Under this study conditions, severe preeclamptic parturients required a 34% reduction of ED 50 of phenylephrine dose compared with normotensive parturients.

          Most cited references28

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          Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.
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            International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia

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              Hypotension in obstetric spinal anaesthesia: a lesson from pre-eclampsia.


                Author and article information

                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                08 July 2022
                : 16
                : 2189-2198
                [1 ]Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine , Hangzhou, People’s Republic of China
                [2 ]Department of Anesthesiology, Affiliated Xiaoshan Hospital, Hangzhou Normal University , Hangzhou, People’s Republic of China
                Author notes
                Correspondence: Xiao-Wei Qian, Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine , Xueshi Road 1, Hangzhou, 310006, People’s Republic of China, Tel +86-571-87061501, Fax +86 571 87061878, Email qianxw@zju.edu.cn
                Author information
                © 2022 Hu et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                : 01 April 2022
                : 28 June 2022
                Page count
                Figures: 3, Tables: 11, References: 28, Pages: 10
                Original Research

                Pharmacology & Pharmaceutical medicine
                cesarean delivery,spinal anesthesia,hypotension,phenylephrine,preeclampsia


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