Dose-response relationship of prophylactic norepinephrine infusion for prevention of spinal anesthesia-induced hypotension during caesarean delivery: A comparative study of normal weight and obese parturients

Xiaoping Chen, Zhenyu Gao, Cuicui Jiao, Jialin Wang, Lihong Sun, Xiaowei Qian, Shuqun Liu

Abstract

Obese parturients are at increased risk of spinal anesthesia–induced hypotension during cesarean delivery, but optimal prophylactic norepinephrine dosing remains unclear. In this randomized, double-blind, dose–response study, 200 parturients undergoing elective cesarean delivery were stratified into obese (BMI ≥30 kg/m²) and normal weight (BMI 18.5–24.9 kg/m²) groups. Within each group, patients received norepinephrine infusion at 0.02–0.06 µg·kg⁻¹·min⁻¹. Standardized combined spinal–epidural anesthesia with 16 mg hyperbaric ropivacaine was used, and infusion was started immediately after spinal injection. Hypotension was defined as SBP <90 mmHg or >20% decrease from baseline, and success as absence of hypotension. Probit regression was used to estimate ED50 and ED95. ED50 and ED95 were 0.022 (95% CI 0.015–0.029) and 0.051 (0.041–0.061) µg·kg⁻¹·min⁻¹ in normal weight, compared with 0.036 (0.029–0.043) and 0.080 (0.058–0.102) µg·kg⁻¹·min⁻¹ in obese parturients. The relative potency ratio was 1.597 (95% CI 1.007–2.187; P=0.013). Neonatal outcomes and maternal adverse effects were comparable. Obese parturients require higher weight-adjusted norepinephrine infusion rates to prevent spinal anesthesia–induced hypotension during cesarean delivery.

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