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Pan ZB, Sheng ZM, Zhu M, Mei Z, Shen YP, Liu JP, Qian XW. Randomized Double-Blinded Comparison of Intermittent Boluses Phenylephrine and Norepinephrine for the Treatment of Postspinal Hypotension in Patients with Severe Pre-Eclampsia During Cesarean Section. Drug Des Devel Ther 2024; 18:639-650. [PMID: 38476203 PMCID: PMC10927372 DOI: 10.2147/dddt.s446657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Background Norepinephrine has fewer negative effects on heart rate (HR) and cardiac output (CO) for treating postspinal hypotension (PSH) compared with phenylephrine during cesarean section. However, it remains unclear whether fetuses from patients with severe pre-eclampsia could benefit from the superiority of CO. The objective of this study was to compare the safety and efficacy of intermittent intravenous boluses of phenylephrine and norepinephrine used in equipotent doses for treating postspinal hypotension in patients with severe pre-eclampsia during cesarean section. Methods A total of 80 patients with severe pre-eclampsia who developed PSH predelivery during cesarean section were included. Eligible patients were randomized at a 1:1 ratio to receive either phenylephrine or norepinephrine for treating PSH. The primary outcome was umbilical arterial pH. Secondary outcomes included other umbilical cord blood gas values, Apgar scores at 1 and 5 min, changes in hemodynamic parameters including CO, mean arterial pressure (MAP), HR, stroke volume (SV), and systemic vascular resistance (SVR), the number of vasopressor boluses required, and the incidence of bradycardia, hypertension, nausea, vomiting, and dizziness. Results No significant difference was observed in umbilical arterial pH between the phenylephrine and norepinephrine groups (7.303±0.38 vs 7.303±0.44, respectively; P=0.978). Compared with the phenylephrine group, the overall CO (P=0.009) and HR (P=0.015) were greater in the norepinephrine group. The median [IQR] total number of vasopressor boluses required was comparable between the two groups (2 [1 to 3] and 2 [1 to 3], respectively; P=0.942). No significant difference was found in Apgar scores or the incidence of maternal complications between groups. Conclusion A 60 µg bolus of phenylephrine and a 4.5 µg bolus of norepinephrine showed similar neonatal outcomes assessed by umbilical arterial pH and were equally effective when treating PSH during cesarean section in patients with severe pre-eclampsia. Norepinephrine provided a higher maternal CO and a lower incidence of bradycardia.
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Affiliation(s)
- Zheng-Bin Pan
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Department of Anesthesiology, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, People’s Republic of China
| | - Zhi-Min Sheng
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Miao Zhu
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhong Mei
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yan-Ping Shen
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Jin-Ping Liu
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiao-Wei Qian
- Department of Anesthesiology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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Skow RJ, Steele AR, Fraser GM, Davenport MH, Steinback CD. The sympathetic muscle metaboreflex is not different in the third trimester in normotensive pregnant women. J Appl Physiol (1985) 2020; 130:640-650. [PMID: 33270512 DOI: 10.1152/japplphysiol.00728.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Isometric handgrip (IHG) is used to assess sympathetic nervous system responses to exercise and may be useful at predicting hypertension in both pregnant and nonpregnant populations. We previously observed altered sympathetic nervous system control of blood pressure in late pregnancy. Therefore, we measured muscle sympathetic nerve activity (MSNA) and blood pressure during muscle metaboreflex activation (IHG) in normotensive pregnant women in the third trimester compared with in healthy nonpregnant women. Further, 19 pregnant (32 ± 3 wk gestation) and 14 nonpregnant women were matched for age, non/prepregnant body mass index (BMI), and parity. MSNA (microneurography), heart rate (ECG), and arterial blood pressure (Finometer) were continuously recorded during 10 min of rest, and then during 2 min of IHG at 30% of maximal voluntary contraction, and 2 min of postexercise circulatory occlusion (PECO). Baseline sympathetic nerve activity (SNA) was elevated in pregnant (41 ± 11 bursts/min) compared with nonpregnant women (27 ± 9 bursts/min; P = 0.005); however, the sympathetic baroreflex gain and neurovascular transduction were not different between groups (P = 0.62 and P = 0.32, respectively). During IHG and PECO, there were no significant differences in the pressor responses (ΔMAP) between groups, (P = 0.25, main effect of group) nor was the sympathetic response different between groups (interaction effect: P = 0.16, 0.25, and 0.27 for burst frequency, burst incidence, and total SNA, respectively). These data suggest that pregnant women who have maintained sympathetic baroreflex and neurovascular transduction also have similar sympathetic and pressor responses during exercise.NEW & NOTEWORTHY We compared sympathetic nervous system activation by muscle metaboreflex between pregnant women in the third trimester and nonpregnant women. We show that the sympathetic nerve activity and associated pressor responses to isometric handgrip and post-exercise circulatory occlusion are not different between third-trimester pregnant and nonpregnant women. These data suggest that unlike other reflexes (e.g., cold pressor test or head-up tilt), metaboreflex control is maintained in pregnant women.
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Affiliation(s)
- Rachel J Skow
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Steele
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Graham M Fraser
- Division of Biomedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
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Sprick JD, Morison DL, Stein CM, Li Y, Paranjape S, Fonkoue IT, DaCosta DR, Park J. Vascular α 1-adrenergic sensitivity is enhanced in chronic kidney disease. Am J Physiol Regul Integr Comp Physiol 2019; 317:R485-R490. [PMID: 31314543 DOI: 10.1152/ajpregu.00090.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is often complicated by difficult-to-control hypertension, in part due to chronic overactivation of the sympathetic nervous system (SNS). CKD patients also exhibit a greater increase in arterial blood pressure for a given increase in sympathetic nerve activation, suggesting an augmented vasoconstrictive response to SNS activation (i.e., neurovascular transduction). One potential mechanism of increased sympathetic neurovascular transduction is heightened sensitivity of the vascular α1-adrenergic receptors (α1ARs), the major effectors of vasoconstriction in response to norepinephrine release at the sympathetic nerve terminals. Therefore, we hypothesized that patients with CKD have increased vascular α1AR sensitivity. We studied 32 patients with CKD stages III and IV (age 59.9 ± 1.3 yr) and 19 age-matched controls (CON, age 63.2 ± 1.6 yr). Using a linear variable differential transformer (LVDT), we measured change in venoconstriction in response to exponentially increasing doses of the selective α1AR agonist phenylephrine (PE) administered sequentially into a dorsal hand vein. Individual semilogarithmic PE dose-response curves were constructed for each participant to determine the PE dose at which 50% of maximum venoconstriction occurred (ED50), reflecting α1AR sensitivity. In support of our hypothesis, CKD patients had a lower PE ED50 than CON (CKD = 2.23 ± 0.11 vs. CON = 2.63 ± 0.20, P = 0.023), demonstrating increased vascular α1AR sensitivity. Additionally, CKD patients had a greater venoconstrictive capacity to PE than CON (P = 0.015). Augmented α1AR sensitivity may contribute mechanistically to enhanced neurovascular transduction in CKD and may explain, in part, the greater blood pressure reactivity exhibited in these patients.
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Affiliation(s)
- Justin D Sprick
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Doree L Morison
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - C Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sachin Paranjape
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ida T Fonkoue
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Dana R DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
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Moreira-Rodrigues M, Graça AL, Ferreira M, Afonso J, Serrão P, Morato M, Ferreirinha F, Correia-de-Sá P, Ebert SN, Moura D. Attenuated aortic vasodilation and sympathetic prejunctional facilitation in epinephrine-deficient mice: selective impairment of β2-adrenoceptor responses. J Pharmacol Exp Ther 2014; 351:243-9. [PMID: 25161169 DOI: 10.1124/jpet.114.217281] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
It has been suggested that there is a link between epinephrine synthesis and the development of β2-adrenoceptor-mediated effects, but it remains to be determined whether this development is triggered by epinephrine. The aim of this study was to characterize β-adrenoceptor-mediated relaxation and facilitation of norepinephrine release in the aorta of phenylethanolamine-N-methyltransferase-knockout (Pnmt-KO) mice. Catecholamines were quantified by reverse-phase high-performance liquid chromatography-electrochemical detection. Aortic rings were mounted in a myograph to determine concentration-response curves to selective β1- or β2-adrenoceptor agonists in the absence or presence of selective β1- or β2-adrenoceptor antagonists. Aortic rings were also preincubated with [(3)H]norepinephrine to measure tritium overflow elicited by electrical stimulation in the presence of increasing concentrations of nonselective β- or selective β2-adrenoceptor agonists. β2-Adrenoceptor protein density was evaluated by Western blotting and β2-adrenoceptor localization by immunohistochemistry. Epinephrine is absent in Pnmt-KO mice. The potency and the maximal effect of the β2-adrenoceptor agonist terbutaline were lower in Pnmt-KO than in wild-type (WT) mice. The selective β2-adrenoceptor antagonist ICI 118,551 [(±)-erythro-(S*,S*)-1-[2,3-(dihydro-7-methyl-1H-inden-4-yl)oxy]-3-[(1-methylethyl)amino]-2-butanol hydrochloride] antagonized the relaxation caused by terbutaline in WT but not in Pnmt-KO mice. Isoproterenol and terbutaline induced concentration-dependent increases in tritium overflow in WT mice only. β2-Adrenoceptor protein density was decreased in membrane aorta homogenates of Pnmt-KO mice, and this finding was supported by immunofluorescence confocal microscopy. In conclusion, epinephrine is crucial for β2-adrenoceptor-mediated vasodilation and facilitation of norepinephrine release. In the absence of epinephrine, β2-adrenoceptor protein density was decreased in aorta cell membranes, thus potentially hindering its functional activity.
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Affiliation(s)
- Mónica Moreira-Rodrigues
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.).
| | - Ana L Graça
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Marlene Ferreira
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.).
| | - Joana Afonso
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Paula Serrão
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Manuela Morato
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Fátima Ferreirinha
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Paulo Correia-de-Sá
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Steven N Ebert
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
| | - Daniel Moura
- Laboratory of General Physiology (M.M.-R.) and Laboratory of Pharmacology and Neurobiology (F.F., P.C.), Unit for Multidisciplinary Investigation in Biomedicine, Institute of Biomedical Sciences Abel Salazar, University of Porto; Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto (A.L.G., M.F., J.A., P.S., D.M.); Neuropharmacology, Institute of Molecular and Cellular Biology, University of Porto (M.M., D.M.); Center for Drug Discovery and Innovative Medicines, University of Porto (M.M.-R., A.L.G., M.F., J.A., P.S., M.M., F.F., P.C., D.M.); Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto and Rede de Química e Tecnologia (REQUIMTE), Porto, Portugal (M.M.); and Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida (S.N.E.)
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