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Category: Volume 08 Issue 02 February 2020
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Title: Prophylactic Intravenous Ephedrine to Prevent Spinal Induced Hypotension during Cesarean Section- A Comparative Study

Authors: Bimal Krushna Panda, Saransh Mishra, Pankaj Verma, Diptimayee Pradhan, Sarita Patnaik, Ratikanta Nayak

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.118

Abstract

   

Background and Aim: Spinal anesthesia is the most common preferred technique for cesarean delivery. Spinal anesthesia provides a fast, profound and symmetrical sensory and motor blockade of high quality in patients undergoing LSCS. However, the most common serious adverse effect of spinal anesthesia for LSCS is hypotension which 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. The study has been undertaken to determine the effect of bolus intravenous ephedrine to be administered to LSCS patients to avoid spinal induced hypotension and to observe the hemodynamic response and the incidence of various side effects to prophylactic bolus dose of intravenous ephedrine.

Materials and Methods: A prospective experimental RCT was conducted with 60 parturients of 18-45 years, scheduled for cesarean section under spinal anaesthesia belonging to ASA Grade I and Grade II fulfilling the inclusion criteria, who were randomly allocated into 2 groups of 30 patients each: Group 1 (Ephedrine 10mg) and Group 2 (Normal saline-control), to be administered intravenously, just after spinal anesthesia.

Results: The incidence of hypotension was 20% and 46.66% in Group-1 and 2, respectively (p=0.008). The occurrence of incidence of hypotension was sooner after spinal anesthesia as well as significantly higher in Group 2 in comparison to Group-1 patients. APGAR score was 9, 9 and 10 respectively at 0min, 1min and 5mins in both the study groups. There is no incidence of nausea in Group-1 whereas it was 6.66% in Group-2 and incidence of vomiting was 6.66% in Group-1 and 30% in Group-2 and that of reactive hypertension was similar among both the groups.

Conclusion: Prophylactic use of intravenous ephedrine significantly decreased the incidence of maternal hypotension without unwanted side effects such as nausea, vomiting and hypertension and improved neonatal outcome as compared to equal volume of normal saline in women posted for elective LSCS and can be of great value in routine practice.

Keywords: Cesarean section, hypotension, intravenous bolus ephedrine, spinal anaesthesia.

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Corresponding Author

Saransh Mishra

Junior Resident, Department of Anaesthesiology, VIMSAR, Burla, Odisha