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  • Title: The median effective seated time for hypotension induced by spinal anesthesia at Cesarean delivery with two doses of hyperbaric bupivacaine: a randomized up-down sequential allocation study.
    Author: Moore A, Bourrassa-Blanchette S, El Mouallem E, Kaufman I, El-Bahrawy A, Li-Pi-Shan W, Hatzakorzian R.
    Journal: Can J Anaesth; 2014 Oct; 61(10):916-21. PubMed ID: 25056277.
    Abstract:
    BACKGROUND: Extending the time a parturient is left sitting after induction of spinal anesthesia (i.e., the seated time) has had varying success in decreasing hypotension at Cesarean delivery. This may be due to the current lack of information concerning the dose-response relationship of seated time and rates of hypotension. METHODS: Term parturients scheduled for Cesarean delivery were randomized to receive 11.25 or 15.0 mg of 0.75% intrathecal hyperbaric bupivacaine, and they remained seated after injection for a length of time determined by an up-down sequential method. They were then placed in a wedged position and their blood pressure was measured every minute. Pre-delivery hypotension was considered present if there was a > 20% from baseline drop in systolic blood pressure. The seated time at which 50% of parturients avoided pre-delivery hypotension (median effective seated time) was determined with isotonic regression. RESULTS: Fifty patients were studied. For the 11.25-mg and 15.0-mg groups, the median effective seated time (95% confidence interval [CI]) was 130 sec (95% CI 117 to 150) and 385 sec (95% CI 381 to 396), respectively. CONCLUSIONS: There exists a seated time after intrathecal injection of hyperbaric bupivacaine where 50% of parturients do not experience hypotension. This seated time increases with an increased dose of bupivacaine. Further work is required to determine the full relationship between seated time and hypotension for other doses of anesthetic and to investigate the clinical utility of this technique for prevention of hypotension. This trial was registered at www.clinicaltrials.gov (NCT01561274).
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