Effect of Adding a Low-Dose Epinephrine Bolus Prior to Infusion on Maternal Hemodynamic Stability During Cesarean Section Under Spinal Anesthesia: A Randomized Clinical Trial

What this Trial Is About

This research evaluates the effects of adding a low-dose epinephrine bolus before continuous infusion on maternal blood pressure stability during cesarean delivery under spinal anesthesia. It focuses on spinal-induced hypotension, a common issue during cesarean sections, comparing epinephrine's impact to current vasopressors like norepinephrine, phenylephrine, and ephedrine. The study aims to clarify whether this approach improves maternal heart rate and cardiac output balance better than infusion alone. Participants are randomly assigned to one of two groups: one receives a 4 mcg epinephrine bolus immediately after spinal anesthesia followed by a continuous infusion of 0.03 mcg/kg/min; the other group receives only the infusion at the same dose without the initial bolus. The epinephrine infusion is prepared by diluting 3000 mcg in 500 mL saline, with infusion rates adjusted by weight. This phase 3 trial uses a double-blind design to compare these interventions during elective cesarean sections. Women aged 18 to 35 undergoing elective lower segment cesarean sections under spinal anesthesia are monitored for up to 2 hours after spinal anesthesia. Researchers will measure the incidence and severity of post-spinal hypotension, episodes of reactive hypertension and tachycardia, nausea and vomiting during surgery, and total norepinephrine use. Fetal outcomes will be assessed through umbilical artery blood gases and Apgar scores shortly after delivery. Safety and maternal hemodynamic stability are closely observed throughout the procedure.

Effect of Adding a Low-Dose Epinephrine Bolus Prior to Infusion on Maternal Hemodynamic Stability During Cesarean Section