Prevention of spinal anesthesia- induced systemic hypotension in elective cesarean section

Abstract EN

Objectives : To compare between the use of intravenous ephedrine as a bolus injection or as an infusion in the prevention of hypotension, and to clarify the side effects associated with elective cesarean section under spinal anesthesia.

Methods : Fifty healthy patients scheduled for elective cesarean section were randomly assigned to one of two groups.

Group one (infusion group) with a mean age of 30.1 years and consisted of 25 patients received ephedrine infusion (0.01% solution, 50 mg ephedrine in 500ml Ringer's lactate).

Group two (bolus group) with a mean age of 28.9 years received 15 mg ephedrine as an intravenous bolus, and additional 6 mg increments, if necessary, when systolic blood pressure decreased below 80 % of the baseline systolic blood pressure or below 100 mm Hg Results: In the infusion group, systolic blood pressure did not change significantly from the baseline systolic blood pressure following spinal anesthesia and reactive hypertension did not occur.

Nausea and/or vomiting occurred in 13 women in the bolus group compared to three patients in the infusion group (p < 0.002).

Conclusion: Prophylactic intravenous infusion of ephedrine was safe and effective in healthy patients undergoing cesarean section under spinal anesthesia for it maintained maternal blood pressure close to the baseline level without causing significant maternal tachycardia, hypertension, nausea and/or vomiting, or fetal compromise.