- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03712111
Comparison of Vasopressor Boluses for Management of Hypotension After Spinal Anesthesia
Study Overview
Status
Detailed Description
Maternal hypotension after subarachnoid block is a frequent and deleterious complication during cesarean delivery. Although prophylaxis against hypotension using vasopressors had become a standard recommendation; the incidence of hypotension is still ∼ 20% . Thus; management of maternal hypotension using vasopressor boluses is usually needed .
The commonly used vasopressors during cesarean delivery are ephedrine, phenylephrine, and recently norepinephrine. The use of ephedrine is usually accompanied with maternal tachycardia and fetal acidosis. Phenylephrine had been the first line for prevention and management of maternal hypotension; however, its use might result in bradycardia and decreased maternal cardiac output .
Norepinephrine is an alpha adrenergic agonist with weak beta adrenergic agonistic activity; thus, it does not cause significant cardiac depression as phenylephrine does. Norepinephrine was introduced for use during cesarean delivery with promising results . Few previous studies investigated the efficacy of Norepinephrine infusion for prevention of maternal hypotension. A dose-response study had investigated the best dose of Norepinephrine for prevention of maternal hypotension. In the aforementioned dose-response study, a dose of 6 mcg was reported as the best dose for prophylaxis against maternal hypotension.
No studies had investigated the best bolus dose of norepinephrine for management of a maternal hypotensive episode. In this study the investigators will investigate the efficacy and side effects of two doses of norepinephrine bolus doses (6 mcg and 10 mcg) in management of maternal hypotensive episode after subarachnoid block during cesarean delivery.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
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Cairo, Egypt, 11432
- Recruiting
- Ahmed Mohamed Hasanin
-
Contact:
- Ahmed M Hasanin
- Phone Number: 1095076954
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- pregnant women
- scheduled for cesarean delivery
Exclusion Criteria:
- patients with severe cardiac dysfunction
- patients with low blood pressure
- patients with ante-partum bleeding
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Norepinephrine 6 mcg
Mothers in this group will receive a bolus of Norepinephrine 6 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
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An intravenous bolus of norepinephrine 6 mcg will be administered for management of maternal hypotension.
Other Names:
Subarachnoid block will be performed using Bupivacaine hydrochloride (2.2 mL) in addition to fentanyl 25 mcg
Other Names:
Prophylactic norepinephrine infusion will be started after subarachnoid block
Other Names:
|
ACTIVE_COMPARATOR: Norepinephrine 10 mcg
Mothers in this group will receive a bolus of Norepinephrine 10 mcg for management of hypotensive episode after spinal anesthesia using Bupivacaine hydrochloride under prophylactic Norepinephrine infusion
|
An intravenous bolus of norepinephrine 10 mcg will be administered for management of maternal hypotension.
Other Names:
Subarachnoid block will be performed using Bupivacaine hydrochloride (2.2 mL) in addition to fentanyl 25 mcg
Other Names:
Prophylactic norepinephrine infusion will be started after subarachnoid block
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of successful management of maternal hypotension
Time Frame: 30 minutes after spinal anesthesia
|
number of patients with successful management of maternal hypotensive episode (defined as return of systolic blood pressure to be ≥ 80% of the baseline reading in the next reading 2 minutes after administration of norepinephrine bolus)
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30 minutes after spinal anesthesia
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Umbilical blood acidity
Time Frame: 10 minutes after delivery
|
the measure of acidity or alkalinity of any solution on a logarithmic scale on which 7 is neutral, lower values are more acid and higher values more alkaline.
|
10 minutes after delivery
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Rate of successful management of severe maternal hypotension
Time Frame: 30 minutes after spinal anesthesia
|
number of patients with successful management of maternal severe hypotensive episode (defined as systolic blood pressure lower than 60% of the baseline reading in the next reading 2 minutes after administration of norepinephrine bolus)
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30 minutes after spinal anesthesia
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incidence of reactive hypertension
Time Frame: 30 minutes after spinal anesthesia
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number of patients with reactive hypertension (defined as systolic blood pressure ≥120% from the baseline reading after administration of norepinephrine bolus)
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30 minutes after spinal anesthesia
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systolic blood pressure
Time Frame: 90 minutes after spinal anesthesia
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systolic blood pressure measured in mmHg
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90 minutes after spinal anesthesia
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heart rate
Time Frame: 90 minutes after spinal block
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number of heart beats per minute
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90 minutes after spinal block
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Apgar score for evaluation of the activity of the fetus
Time Frame: 10 minutes
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the Apgar score of the fetus which range from 0 to 10. Th minimum value is 0 and the maximum value is 10.
The worst value is 0 and the best value is 10
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10 minutes
|
The frequency of vomiting
Time Frame: 90 minutes after spinal anesthesia
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The number of patients with vomiting
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90 minutes after spinal anesthesia
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Hypotension
- Physiological Effects of Drugs
- Adrenergic Agents
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Autonomic Agents
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Adrenergic alpha-Agonists
- Adrenergic Agonists
- Anesthetics, Local
- Sympathomimetics
- Vasoconstrictor Agents
- Bupivacaine
- Norepinephrine
Other Study ID Numbers
- N-71-2018
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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