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Category: Volume 05 Issue 12 December 2017
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Title: Ephedrine Infusion Instead of Crystalloid Preloading to Prevent Spinal Hypotension in Lower Abdominal Surgeries

Authors: Divya Madhu, Sheeja Krishnan, Rehana.B, P. Geethakumari

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.161

Abstract

Spinal anesthesia is one of the most popular techniques for lower limb and lower abdominal procedures. Various prophylactic methods like prehydration, head up position and vasopressors have been used to minimize hypotension associated with it. In our study, we used prophylactic Ephedrine infusion to prevent hypotension, in spinal anaesthesia. 80 ASA I and II patients aged 20 to 60 years were randomly allocated into two equal groups. Group 1 received prophylactic intravenous infusion of Ephedrine at the rate of 5mg/min for the first two minutes followed by 1mg/min for the next 18 minutes following spinal block. Group 2 received crystalloid preloading at 15 ml/kg over 15 to 20 minutes before spinal block. Patients in both the groups were given maintenance infusion of crystalloid at the rate of 5ml/kg for 20 minutes after spinal block and according to requirement thereafter. Hypotension was taken as more than 20% fall in Systolic BP from baseline. The occurrence of any side effects was also monitored. Incidence of hypotension was significantly higher in the control group (82.2%) vs Ephedrine group (22.5%); p <0.001. Additional Ephedrine boluses needed to treat hypotension was significantly lower in Ephedrine group (p < 0.001). No side effects were noted in 67.5% patients in Ephedrine group compared to 62.5% for control group. There was 7.5% incidence of reactive hypertension(>140/90 mm hg) and 20% had tachycardia (>100/ min) in the Ephedrine group. Administration of prophylactic Ephedrine infusion is a suitable alternative to preloading with crystalloids. Incidence of hypotension is lower and BP maintains a more stable trend. But it is safe to avoid it in patients with preexisting tachycardia or hypertension.

Keywords: ephedrine, crystalloids, preloading, spinal anaesthesia, lower abdominal surgeries.

References

  1. Wulf HFW. The Centennial of Spinal Anesthesia. Anesthesiology 1998; 89(2): 500-6.
  2. Hawkins JL, Arens JF, Bucklin BA, et al. Practice guidelines for obstetric anesthesia: An updated report by the American Society of Anesthesiologists Task Force on obstetric anesthesia. Anesthesiology 2007; 106(4): 843-63.
  3. Collins VJ. Principles of anesthesiology: general and regional anesthesia. 3rd ed ed. Philadelphia: Lea & Febiger; 1993.
  4. Miller's anesthesia. 6th ed ed. New York: Elsevier/Churchill Livingstone; 2005.
  5. Malhotra HBDK. Evaluation of preloading and vasoconstrictors as a combined prophylaxis for hypotension during subarachnoid anaesthesia. Indian Journal of Anaesthesia 2004; 48(4): 299-303.
  6. Burns SM, Cowan CM, Wilkes RG. Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice. Anaesthesia 2001; 56(8): 777-98.
  7. Lee A, Kee WDN, Gin T. Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: a quantitative systematic review. Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2002; 49(6): 588-99.
  8. Venn PJH, Simpson DA, Rubin AP, Edstrom HH. Effect Of Fluid Preloading On Cardiovascular Variables After Spinal Anaesthesia With Glucose-Free 0.75% Bupivacaine. BJA: British Journal of Anaesthesia 1989; 63(6): 682-7.
  9. Coe AJ, Revanäs B. Is crystalloid preloading useful in spinal anaesthesia in the elderly? Anaesthesia 1990; 45(3): 241-3.
  10. d'A Stanton-Hicks M. A STUDY USING BUPIVACAINE FOR CONTINUOUS PERIDURAL ANALGESIA IN PATIENTS UNDERGOING SURGERY OF THE HIP. Acta Anaesthesiologica Scandinavica 1971; 15(2): 97-106.
  11. Bromage PR. Epidural Air Bubbles and Frothy Syllogisms. Anesthesia & Analgesia 1988; 67(1): 93.
  12. Clark RB, Thompson DS, Thompson CH. Prevention of Spinal Hypotension Associated with Cesarean Section. Anesthesiology 1976; 45(6): 670-3.
  13. Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at Caesarean section. British Journal of Anaesthesia 1995; 75(3): 262-5.
  14. Kang YG, Abouleish E, Caritis S. Prophylactic Intravenous Ephedrine Infusion during Spinal Anesthesia for Cesarean Section. Anesthesia & Analgesia 1982; 61(10): 839???42.
  15. Kundra S, Abraham V, Afzal L. Prevention of hypotension during spinal anaesthesia for caesarean section: Ephedrine infusion versus crystalloid preloading. Journal of Anaesthesiology Clinical Pharmacology 2008; 24(4): 433-6.
  16. Idehen H, Amadasun F, Ekwere I. Comparison of intravenous colloid and colloid-crystalloid combination in hypotension prophylaxis during spinal anesthesia for cesarean section. Nigerian Journal of Clinical Practice 2014; 17(3): 309-13.
  17. Bhattacharya D, Chowdhury M, Biswas B, Gazi N, Rudra A, Banerjee A. Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anaesthesia for elective caesarean section. Indian Journal of Anaesthesia 2001; 45(4): 290-93.
  18. Gutsche BB. Prophylactic Ephedrine Preceding Spinal Analgesia for Cesarean Section. Anesthesiology 1976; 45(4): 462-5.
  19. Nakayama M, Kanaya N, Fujita S, Namiki A. Effects of Ephedrine on Indocyanine Green Clearance During Spinal Anesthesia. Anesthesia & Analgesia 1993; 77(5): 947???9.
  20. Gajraj NM, Victory RA, Pace NA, Van Elstraete AC, Wallace DH. Comparison of an Ephedrine Infusion with Crystalloid Administration for Prevention of Hypotension During Spinal Anesthesia. Anesthesia & Analgesia 1993; 76(5): 1023???6.
  21. Eroglu F, Yavuz L, Ceylan BG, Sevin G, Soyupek S. Prophylactic Effects of Systemic Oral Ephedrine in Spinal Anesthesia-induced Hypotension during Transurethral Prostatectomy. Scandinavian Journal of Urology and Nephrology 2003; 37(2): 145-50.

Corresponding Author

Dr Sheeja Krishnan

Assistant Professor, Dept of Anaesthesiology,

Government Medical College, Thiruvananthapuram, Kerala.

Telephone Number:  9447525228, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.