Key result
Prophylactic intravenous ephedrine infusion significantly reduced the incidence of hypotension compared to crystalloid preloading (24% vs 48%, p=0.03) in parturients undergoing cesarean section under spinal anesthesia.
Why the study?
Does prophylactic IV ephedrine infusion prevent hypotension better than crystalloid preloading in pregnant women undergoing cesarean section under spinal anesthesia?
RCT (n=50)
Closed envelope method
No
Does prophylactic IV ephedrine infusion prevent hypotension better than crystalloid preloading in pregnant women undergoing cesarean section under spinal anesthesia?
Absolute Event Rate: 24% vs 48%
p-value: p=0.03
Prophylactic IV ephedrine infusion is more effective than crystalloid preloading in preventing hypotension during spinal anesthesia for cesarean section.
Supports prophylactic ephedrine infusion to prevent spinal hypotension in cesarean delivery; strengthens evidence for vasopressor-first strategies in obstetric anesthesia.
Background: Spinal anesthesia is used for 95% of planned cesarean sections in the United States. It provides a fast and profound sensory and motor block. However, hypotension is a very common complication of spinal anesthesia during cesarean section, causing significant morbidity and mortality. It could be associated with severe nausea, vomiting and even unconsciousness and pulmonary aspiration in the mother and for the baby, hypoxia, acidosis, and neurological injuries may result. Methodology: Fifty patients were randomly allocated into two groups. Group I (F group) patients received preloading with 15 ml/kg Ringer lactate before induction of spinal anesthesia, and group II (E group) patients received IV ephedrine (5 mg in 1st minute after spinal anesthesia and 5 mg in the 2nd minute and 1 mg every minute after that for 15 minutes). Results: A statistically significant difference in the incidence of hypotension between group F (48%) and group E (24%) was seen, (p-value 0.03). Regarding side effects, the incidence of nausea and vomiting was higher in the group F (20%) when compared to group E (12%), (p-value 0.23). Conclusions: We concluded that IV infusion of ephedrine after induction of spinal anesthesia was more effective than crystalloid preloading in a prevention of hypotension in parturient undergoing cesarean section and did so without causing significant tachycardia.
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Ahmed et al. (2016) conducted an RCT in Hypotension during spinal anesthesia for cesarean section (n=50). Ephedrine infusion vs. Crystalloid preloading (15 ml/kg Ringer lactate) was evaluated on Incidence of hypotension (20% decrease in systolic blood pressure from baseline) (p=0.03). Prophylactic intravenous ephedrine infusion significantly reduced the incidence of hypotension compared to crystalloid preloading (24% vs 48%, p=0.03) in parturients undergoing cesarean section under spinal anesthesia.
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