Prevention of Maternal Hypotension During Cesarean Section With Norepinephrine Infusion.
Condition: Hypotension; Obstetric Anesthesia Problems; Cesarean Section Complications; Hypotensive; Vasoconstriction
MeSH terms: Hypotension
Study type: Interventional

Summary: 
      This will be a randomized study aiming at investigating the combination of a norepinephrine
      infusion and colloid preloading versus the combination of a norepinephrine infusion and
      crystalloid co-loading for the prevention of maternal hypotension during elective cesarean
      section
    

Detailed description: 
      Neuraxial techniques are the anesthetic techniques of choice in contemporary obstetric
      anesthesia practice, with a definitive superiority as compared to general anesthesia, since,
      by their use, serious complications involving the airway can be avoided.Spinal anesthesia has
      become the favorable technique for both elective and emergency cesarean section due to a
      quick and predictable onset of action, however, it can be frequently complicated by
      hypotension, with incidence exceeding 80% occasionally. Recently, noradrenaline has been
      shown to be effective in maintaining blood pressure in obstetric patients. Another technique
      widely used to prevent hypotension is fluid administration. Current evidence suggests that
      the combination of fluid administration and vasoconstrictive medications should be the main
      strategy for prevention and management of hypotension accompanying neuraxial anesthesia
      procedures during cesarean section. Research is still underway in relation to the most
      appropriate timing for fluid administration, the most appropriate fluid volume as well as the
      type of fluid that should be administered. However, preloading of crystalloids seems to be
      inefficient as a sole strategy, while co-loading of colloids is more effective than
      co-loading of crystalloids for prevention of hypotension in the parturient. On the other
      hand, preloading and co-loading of colloids seem to be of equal effectiveness. Literature is
      rather scarce regarding the comparison of colloid preloading and crystalloid co-loading.

      The aim of this randomized study will be to investigate the combination of a norepinephrine
      infusion and colloid preloading versus the combination of a norepinephrine infusion and
      crystalloid co-loading for the prevention of maternal hypotension during elective cesarean
      section.
    

Intervention name(s): norepinephrine infusion and colloid preloading (NOR-COL); norepinephrine infusion and crystalloid co-loading (NOR-CRYST)
Intervention type(s): Procedure; Procedure
Intervention description(s): in parturients allocated to the NOR-COL group, a norepinephrine infusion will be started as soon as spinal anesthesia is initiated. This group will also receive 5 mL/kg of colloid infusion prior to the initiation of spinal anesthesia; in parturients allocated to the NOR-CRYST group, a norepinephrine infusion will be started as soon as spinal anesthesia is initiated. This group will also receive 10 mL/kg of crystalloid infusion simultaneously with the initiation of spinal anesthesia
Intervention MeSH terms: Norepinephrine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention