HEMODYNAMIC EFFECTS OF SIMULTANEOUS ADMINISTRATION OF INTRAVENOUS EPHEDRINE AND SPINAL ANESTHESIA FOR CESAREAN DELIVERY

Abstract

Background: In the anesthesia practice prevention and management of hypotension related to spinal anesthesia remains a difficult problem and there was no consensus on its optimal management. The incidence of hypotension during spinal anesthesia for cesarean section is reported to be as high as 80%, despite fluid preload and lateral uterine displacement. Ephedrine, an indirectly acting sympathomimetic amine is probably the vasopressor of choice in obstetric anesthesia. Although ephedrine has mixed α and β adrenoreceptor activity it maintains arterial pressure mainly by increase in cardiac output and heart rate as a result of its predominant activity on β-1 adrenoreceptor. It may cause maternal tachycardia. It has less effect on uteroplacental blood flow as compared to other vasopressors.³

Objectives: This study was conducted to observe hemodynamic effects of ephedrine in spinal anesthesia during cesarean delivery on mother and to study the incidence of hypotension in the compared groups.

Methods: A prospective randomized double blind study. 100 ASA (American society of Anesthesiology) physical status I and II women undergoing elective cesarean delivery divided into study and control groups. Study group was received IV dose of 20 mg (2 ml) ephedrine over 60 seconds simultaneously with intrathecal dose of 2 ml 0.5% heavy bupivacaine. Control group was received IV 2 ml saline simultaneously with intrathecal dose of 2 ml 0.5% heavy bupivacaine.

Results: After 5 minutes mean pulse rate in group B is significantly lower than those of group A (p<0.05). Fall in blood pressure in group B is significantly more as compared to group A (p<0.05). First rescue ephedrine time in group A is significantly more than group B (p<0.05). No difference in apgar score at 1minute and at 5 minute between the study groups. Incidence of hypotension, bradycardia, nausea and vomiting are significantly higher in group B as compared to group A.

Conclusion: Prophylactic bolus dose of 20 mg intravenous ephedrine given at the time of intrathecal block and after 10 ml/kg intravenous crystalloids preload reduce the incidence and severity of hypotension.