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Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled.

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Presentation on theme: "Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled."— Presentation transcript:

1 Antepartum continuous epidural ropivacaine therapy reduces uterine artery vascular resistance in pre-eclampsia: a randomized, dose-ranging, placebo-controlled study†  Y. Ginosar, M. Nadjari, A. Hoffman, N. Firman, E.M. Davidson, C.F. Weiniger, L. Rosen, C. Weissman, U. Elchalal  British Journal of Anaesthesia  Volume 102, Issue 3, Pages (March 2009) DOI: /bja/aen402 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

2 Fig 1 The CONSORT flowchart for randomized controlled trials.
British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

3 Fig 2 Doppler indices for vascular resistance and uterine artery notching. (a) Doppler ultrasound of the uterine artery showing normal flow. The systolic, average, and diastolic velocities are identified; these are used to derive the commonly used Doppler indices for determining vascular resistance, PI=(systolic−diastolic)/average, resistance index=(systolic−diastolic)/systolic, systolic/diastolic ratio=systolic/diastolic. (b) Reduced flow with mild notch and (c) severely reduced flow with severe notch (see arrows). (b) and (c) were derived from the baseline uterine artery Doppler velocimetry from the super-responder in the non-responsive and the responsive uterine artery, respectively. British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

4 Fig 3 Doppler indices of uterine artery vascular resistance in ACET Stage 1 dose–response effect. Doppler indices of vascular resistance on the y-axis are inversely correlated with blood flow. In (a), (c), and (e), baseline PI is represented as a horizontal dotted line, whereas in (b), (d), and (f), the PI, resistance index, and systolic–diastolic ratio are each expressed as percentage change from baseline. Placebo is represented as the zero dose in the dose–response curve. Error bars represent sd. *Significant difference from baseline (P < 0.05). British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

5 Fig 4 Doppler indices of uterine artery vascular resistance in ACET Stage 1-on/off temporal effect. As the placebo dose always followed the 0.1% dose, (a), (b), and (c) represent PI on a continuous time axis corresponding to the baseline, 0.1%, and placebo doses. The three patients who remained in ACET Stage 2 long enough to receive a second placebo dose are also represented in this figure (circles); in those cases, the data for the 0.1% dose are from the last ultrasound before the second placebo dose. *Significant difference from baseline (P < 0.05). British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

6 Fig 5 The responsive uterine artery had higher baseline PI. Baseline (Day 0) uterine artery PI is represented on the y-axis. In all patients, the vessel that responded to ACET had higher baseline PI than its pair. *Significant difference from non-responding vessel (P < 0.05). British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

7 Fig 6 Intrauterine fetal growth during ACET. Data from the four patients who participated in ACET Stage 2 (including the patient who delivered before the second placebo day). Estimated fetal weight measurements at time intervals during the study, with reference to the 5th, 10th, 50th, and 90th percentiles, determined by an average of male and female normograms.23 British Journal of Anaesthesia  , DOI: ( /bja/aen402) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions


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