Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section
Abstract Background The use of a fluid co-load has been shown to enhance hemodynamic stability and diminish the occurrence of hypotension after spinal anesthesia when paired with prophylactic norepinephrine. This research aimed to identify the effective dosages (ED90 and ED50) of prophylactic norepi...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-025-02913-6 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832585412246241280 |
|---|---|
| author | Chengfei Xu Peipei Zhang Chunying Dai Jingjun Zhang Honghao Wu Qianying Liu Zhiqiang Zhang Fengwei Yin Huadong Ni Liang Cheng |
| author_facet | Chengfei Xu Peipei Zhang Chunying Dai Jingjun Zhang Honghao Wu Qianying Liu Zhiqiang Zhang Fengwei Yin Huadong Ni Liang Cheng |
| author_sort | Chengfei Xu |
| collection | DOAJ |
| description | Abstract Background The use of a fluid co-load has been shown to enhance hemodynamic stability and diminish the occurrence of hypotension after spinal anesthesia when paired with prophylactic norepinephrine. This research aimed to identify the effective dosages (ED90 and ED50) of prophylactic norepinephrine boluses, in conjunction with a crystalloid co-load, for the prevention of hypotension after spinal anesthesia in cesarean delivery patients. Methods Patients were administered crystalloid co-loads at a dosage of 10 mL/kg, in addition to preventive norepinephrine dosages direct following spinal anesthesia administration. The dosages of norepinephrine were established employing the up-and-down sequential allocation technique, starting with 8 µg and progressively rising by 1 µg increments. The primary objective was to detect the effective dosage (ED90 and ED50) of norepinephrine necessary to avoid hypotension following spinal anesthesia. Results The ED90 for a single norepinephrine bolus, in combination with a crystalloid co-load, was calculated to be 5.35 µg (95% CI: 4.75 to 7.13). The ED50 was determined to be 4.05 µg (95% CI: 3.68 to 4.46) using the up-and-down method and 3.926 µg (95% CI: 3.362 to 4.422) through the probit regression model. Conclusion A prophylactic norepinephrine bolus of 5.35 µg, administered with a crystalloid co-load, effectively prevents hypotension following the spinal anesthesia in cesarean delivery patients. |
| format | Article |
| id | doaj-art-3263df1079ad431dbcbcb75d440abe51 |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-3263df1079ad431dbcbcb75d440abe512025-01-26T12:49:54ZengBMCBMC Anesthesiology1471-22532025-01-012511910.1186/s12871-025-02913-6Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean sectionChengfei Xu0Peipei Zhang1Chunying Dai2Jingjun Zhang3Honghao Wu4Qianying Liu5Zhiqiang Zhang6Fengwei Yin7Huadong Ni8Liang Cheng9Department of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Obstetrics and Gynecology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology, The Third People’s Hospital of BengbuDepartment of Anesthesiology and Pain Research center, The Affiliated Hospital of Jiaxing UniversityDepartment of Anesthesiology, The Third People’s Hospital of BengbuAbstract Background The use of a fluid co-load has been shown to enhance hemodynamic stability and diminish the occurrence of hypotension after spinal anesthesia when paired with prophylactic norepinephrine. This research aimed to identify the effective dosages (ED90 and ED50) of prophylactic norepinephrine boluses, in conjunction with a crystalloid co-load, for the prevention of hypotension after spinal anesthesia in cesarean delivery patients. Methods Patients were administered crystalloid co-loads at a dosage of 10 mL/kg, in addition to preventive norepinephrine dosages direct following spinal anesthesia administration. The dosages of norepinephrine were established employing the up-and-down sequential allocation technique, starting with 8 µg and progressively rising by 1 µg increments. The primary objective was to detect the effective dosage (ED90 and ED50) of norepinephrine necessary to avoid hypotension following spinal anesthesia. Results The ED90 for a single norepinephrine bolus, in combination with a crystalloid co-load, was calculated to be 5.35 µg (95% CI: 4.75 to 7.13). The ED50 was determined to be 4.05 µg (95% CI: 3.68 to 4.46) using the up-and-down method and 3.926 µg (95% CI: 3.362 to 4.422) through the probit regression model. Conclusion A prophylactic norepinephrine bolus of 5.35 µg, administered with a crystalloid co-load, effectively prevents hypotension following the spinal anesthesia in cesarean delivery patients.https://doi.org/10.1186/s12871-025-02913-6Crystalloid co-loadNorepinephrinePost-spinal anesthesia hypotensionCesarean section |
| spellingShingle | Chengfei Xu Peipei Zhang Chunying Dai Jingjun Zhang Honghao Wu Qianying Liu Zhiqiang Zhang Fengwei Yin Huadong Ni Liang Cheng Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section BMC Anesthesiology Crystalloid co-load Norepinephrine Post-spinal anesthesia hypotension Cesarean section |
| title | Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section |
| title_full | Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section |
| title_fullStr | Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section |
| title_full_unstemmed | Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section |
| title_short | Up-and-down determination of prophylactic norepinephrine boluses combined with crystalloid co-load for preventing post-spinal anesthesia hypotension during cesarean section |
| title_sort | up and down determination of prophylactic norepinephrine boluses combined with crystalloid co load for preventing post spinal anesthesia hypotension during cesarean section |
| topic | Crystalloid co-load Norepinephrine Post-spinal anesthesia hypotension Cesarean section |
| url | https://doi.org/10.1186/s12871-025-02913-6 |
| work_keys_str_mv | AT chengfeixu upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT peipeizhang upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT chunyingdai upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT jingjunzhang upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT honghaowu upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT qianyingliu upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT zhiqiangzhang upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT fengweiyin upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT huadongni upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection AT liangcheng upanddowndeterminationofprophylacticnorepinephrinebolusescombinedwithcrystalloidcoloadforpreventingpostspinalanesthesiahypotensionduringcesareansection |