title: Impact of cafedrine/theodrenaline (Akrinor® ) on therapy of maternal hypotension during spinal anesthesia for Cesarean delivery: a retrospective study.
abstract: OBJECTIVE
  Maternal hypotension is the most frequent complication in spinal anesthesia for Cesarean delivery. Malperfusion of the foetus and nausea and vomiting of the mother are hallmarks of maternal hypotension. In this retrospective data analysis and anesthesia protocols we have investigated to explore the effects of therapeutic interventions for hypotension with cafedrine/theodrenaline (Akrinor® ) during spinal anesthesia for elective Cesarean section.
  
  
  METHODS
  In a retrospective study anesthesia charts of 173 parturients undergoing spinal anesthesia for Cesarean delivery with 10mg hyperbaric bupivacaine + 5 µg sufentanil were reviewed for 30 min after onset of hypotension with respect to blood pressure, heart rate, respiration rate, as well as APGAR scores and umbilical arterial pH. Maternal data were compared to baseline values recorded and documented immediately before placing the spinal anesthesia in the operating room. The cohort was divided into two groups according to their hemodynamic response to spinal anesthesia: 117 parturients had a drop of systolic blood pressure to <120 mmHg or <80% of baseline blood pressure and were therefore treated with Akrinor® (cafedrine/theodrenaline; treatment group); 56 patients remained within the specified limits (non-treatment group). Maternal cardiovascular parameters and newborn outcome between the groups were compared.
  
  
  RESULTS
  Both groups were comparable with regard to baseline characteristics. In the treatment group one minute after the first application of cafedrine (43 mg)/theodrenaline (2.2 mg) mean systolic blood pressure raised from 108.6 mmHg to 117.2 mmHg (P=0.0004), mean of maximal changes of systolic blood pressure after the first application of Akrinor® was 21.3 mmHg. Blood pressure levels of the non-treatment group were regained in the treatment group 8 min after hypotension onset and remained at that level until the end of 30 min observation. No clinically relevant changes of heart rate were detectable. While mean APGAR score one minute post partum was significantly higher in the treatment group (8.9±1.2 vs. 8.4±1.1 P=0.043), mean umbilical arterial cord pH was 7.3±0.1 and APGAR scores 5 and 10 minutes postpartum did not differ significantly.
  
  
  CONCLUSIONS
  The results of this study confirm a rapid and sustained increase in blood pressure after application of Akrinor® for treatment of sympathicolysis induced hypotension. No negative impact of Akrinor® on umbilical arterial cord pH and APGAR scores was observed.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine, Palliative Medicine and Pain Therapy, Malteser Hospital Bonn/Rhein-SiegUniversity of Bonn, Bonn, Germany. katri-elina.clemens@malteser.org
authors.forename: K E
authors.initials: KE
authors.lastname: Clemens
authors.forename: I
authors.initials: I
authors.lastname: Quednau
authors.forename: A R
authors.initials: AR
authors.lastname: Heller
authors.forename: E
authors.initials: E
authors.lastname: Klaschik
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D002585:Cesarean Section / Q000379:methods; D004338:Drug Combinations; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D007231:Infant, Newborn; D008499:Medical Records; D009325:Nausea / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013806:Theophylline / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D004338:Drug Combinations; C000147:cafedrine, theodrenaline drug combination; D013806:Theophylline