Open Access Open Access  Restricted Access Subscription Access

Effects of Ephedrine Infusion for the Prevention of Hypotension during Spinal Anesthesia for Elective LSCS


Affiliations
1 Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, India
 

Spinal anesthesia provides a fast, profound and symmetrical sensory and motor blockade of high quality in patients undergoing LSCS1. However, the most common serious adverse effect of spinal anesthesia for LSCS is hypotension. Maternal hypotension has detrimental effects on uterine blood flow causing fetal hypoxia and acidosis. Preloading with crystalloids and use of vasopressors is widely recommended to prevent hypotension. We designed a study to determine the effects of ephedrine infusion for control of hypotension in women undergoing elective LSCS. In this observational study 80 parturients in the age group of 20 to 40 years, posted for elective caesarean section and belonging to ASA class 1 and 2 were selected. After preloading with 500 ml of ringer lactate solution, all the patients received spinal anaesthesia with 2ml inj.bupivacaine 0.5% (heavy). Immediately after institution of subarachnoid block the infusion of ephedrine at the rate of 1.25 mg/min via an infusion pump was started and was continued till clamping of the umbilical cord. The incidence of hypotension was 11% which was found to be lower when compared with other studies. Average dose of ephedrine used was 17±2 mg. Average APGAR score in our study were found to be 8 and 9 at 1 and 5 minutes. No neonate had an APGAR score below 7. The incidence of nausea and vomiting was 6% and that of reactive hypertension was 2%. None of the patients had tachycardia, bradycardia or shivering. We concluded that, prophylactic intra-venous ephedrine infusion immediately after spinal anesthesia is a quick, simple, safe and effective technique in preventing hypotension without unwanted side effects such as nausea, vomiting and hypertension in women posted for elective LSCS and can be of great value in routine practice. Being an observation study, comparison with a control group is recommended for comments on efficacy.

Keywords

Cesarean Section, Ephedrine Infusion, Hypotension, Spinal Anesthesia.
Font Size

User
Notifications

  • Kol IO, Kaygusuz K, Gursoy S, Cetin A, Kahramanoglu Z, Ozkan F, Mimaroglu C. The effects of intravenous ephedrine during spinal anesthesia for caesarean delivery: A randomized controlled trial. J Korean Med Sci. 2009 Oct; 24(5):883–8. https://doi.org/10.3346/jkms.2009.24.5.883 PMid:19794988 PMCid:PMC2752773
  • Lee A, Ngan Kee WD, Gin T. A quantitative, systematic review of randomized controlled trials of ephedrineversus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2002; 94:920–6. https://doi.org/10.1097/00000539-200204000-00028 PMid:11916798
  • Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006; 4:CD002251. [PubMed]. https://doi.org/10.1002/14651858.CD002251.pub2
  • Bhattacharya D, Chaudhary M, Biswas B, Gazi N. Comparison of ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anesthesia for elective caesarean section. Indian J Anaesth. 2001; 45(4):290.
  • Rout CC1, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective caesarean section. Br J Anaesth. 1992 Apr; 68(4):394–7. https://doi.org/10.1093/bja/68.4.394 PMid:1642918
  • Ngan Kee WD, Khaw KS, Ng FF, Lee BB. Prophylactic phenylephrine infusion for preventing hypotension during spinal anesthesia for cesarean delivery. Anesth Analg. 2004; 98:815–21. https://doi.org/10.1213/01. ANE.0000099782.78002.30 PMid:14980943
  • Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005; 103:744– 50. https://doi.org/10.1097/00000542-200510000-00012 PMid:16192766
  • Dyer RA, Reed AR. Spinal hypotension during elective cesarean delivery: Closer to a solution. Anesth Analg. 2010; 111:1093–5. https://doi.org/10.1213/ ANE.0b013e3181ea5f77 PMid:20971959
  • Gunusen I, Karaman S, Ertugrul V, Firat V. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care. 2010 Jul; 38(4):647–53. PMid:20715726
  • Aragão FF, Aragão PW, Martins CA, Salgado Filho N, Barroqueiro Ede S. Comparison of metaraminol, phenylephrine and ephedrine in prophylaxis and treatment of hypotension in cesarean section under spinal anesthesia. Rev Bras Anestesiol. 2014 Sep-Oct; 64(5):299–306. https://doi.org/10.1016/j.bjan.2013.07.014 PMid:25168433
  • Kansal A, Mohta M, Sethi AK, Tyagi A, Kumar P. Randomised trial of intravenous infusion of ephedrine or mephentermine for management of hypotension during spinal anaesthesia for Caesarean section. Anaesthesia. 2005 Jan; 60(1):28–34. https://doi.org/10.1111/j.1365-2044.2004.03994.x PMid:15601269
  • Gulhas N, Tekdemir D, Durmus M, Yucel A, Erdil FA, Yologlu S, Ersoy MO. The effects of ephedrine on maternal hypothermia in caesarean sections: A double blind randomized clinical trial. Eur Rev Med Pharmacol Sci. 2013; 17(15):2051–8. PMid:23884826

Abstract Views: 18

PDF Views: 0




  • Effects of Ephedrine Infusion for the Prevention of Hypotension during Spinal Anesthesia for Elective LSCS

Abstract Views: 18  |  PDF Views: 0

Authors

Rewati Khairnar
Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, India
Sunita Sankalecha
Department of Anaeshthesia, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, India

Abstract


Spinal anesthesia provides a fast, profound and symmetrical sensory and motor blockade of high quality in patients undergoing LSCS1. However, the most common serious adverse effect of spinal anesthesia for LSCS is hypotension. Maternal hypotension has detrimental effects on uterine blood flow causing fetal hypoxia and acidosis. Preloading with crystalloids and use of vasopressors is widely recommended to prevent hypotension. We designed a study to determine the effects of ephedrine infusion for control of hypotension in women undergoing elective LSCS. In this observational study 80 parturients in the age group of 20 to 40 years, posted for elective caesarean section and belonging to ASA class 1 and 2 were selected. After preloading with 500 ml of ringer lactate solution, all the patients received spinal anaesthesia with 2ml inj.bupivacaine 0.5% (heavy). Immediately after institution of subarachnoid block the infusion of ephedrine at the rate of 1.25 mg/min via an infusion pump was started and was continued till clamping of the umbilical cord. The incidence of hypotension was 11% which was found to be lower when compared with other studies. Average dose of ephedrine used was 17±2 mg. Average APGAR score in our study were found to be 8 and 9 at 1 and 5 minutes. No neonate had an APGAR score below 7. The incidence of nausea and vomiting was 6% and that of reactive hypertension was 2%. None of the patients had tachycardia, bradycardia or shivering. We concluded that, prophylactic intra-venous ephedrine infusion immediately after spinal anesthesia is a quick, simple, safe and effective technique in preventing hypotension without unwanted side effects such as nausea, vomiting and hypertension in women posted for elective LSCS and can be of great value in routine practice. Being an observation study, comparison with a control group is recommended for comments on efficacy.

Keywords


Cesarean Section, Ephedrine Infusion, Hypotension, Spinal Anesthesia.

References





DOI: https://doi.org/10.18311/mvpjms%2F2019%2Fv6i1%2F11041