///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Different preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia

Abstract Number: 77
Abstract Type: Original Research

Berrin Gunaydin Prof1 ; Fatma Faydaci MD2; Berrin Gunaydin Prof3

Introduction: Various methods have been employed to reduce the incidence of hypotension associated with spinal anesthesia for cesarean section (C/S). These include different preloading protocols with crystalloids or colloids and/or prophylactic intramuscular and intravenous (IV) bolus or infusion of vasopressors. We aimed to investigate the effects of different volumes of crystalloid preloading before spinal block with constant ephedrine infusion started after spinal anesthesia for the prevention of hypotension due to spinal anesthesia during elective C/S.

Methods: After IRB approval, 90 parturients undergoing C/S were randomly allocated into three groups as Group 10RL, Group 15RL or Group 20RL to administer 10, 15 or 20 mL/kg of Ringers lactate (RL) solution intravenously within 15 minutes (min) before spinal block. Following routine monitorization, spinal anesthesia was performed with hyperbaric bupivacaine 12 mg + morphine 100 g + fentanyl 10 g. Then, operating table was tilted left and IV ephedrine of 3 mg/min was immediately administered by an infusion pump and continued until umbilical cord clamping in all groups. Sensory and motor block characteristics, hemodynamic parameters were recorded every 2 min until umbilical cord clamping. When mean arterial pressure (MAP) decreased by more than 20% from baseline, it was treated with 10 mg of additional bolus IV ephedrine. After delivery, blood gas analysis was performed in the umbilical artery (UA) and vein (UV). Total amount of ephedrine (infusion + additional bolus), Apgar scores (1 and 5 min), and the incidence of hypotension, nausea and vomiting were recorded.

Data were analyzed with One way ANOVA followed by post hoc correction among the groups and T-test for comparison between independent and within dependent groups.

Results: Sensory and motor block characteristics, 5 min Apgar scores and pH, HCO3 and BE values in the UA and UV were comparable among the groups. Median 1 min Apgar score in Group 20RL was significantly higher than that of the Group 10RL. Significant decrease in the MAP with respect to baseline was observed 2 min after spinal block in Group 10RL, whereas it was observed 4 min after spinal block in Groups 15RL and 20RL. The incidences of hypotension were 60%, 36.7% and 13.4% in the groups 10RL, 15RL and 20RL, respectively (p<0.05). Additional bolus IV ephedrine dose was least in Group 20RL when compared to the other groups (p<0.05). Total amount of ephedrine dose were 49.913.5, 46.413.4 and 38.48.5 mg in the groups 10RL, 15RL and 20RL, respectively (p<0.05). Median total nausea-vomiting score in Group 20RL was significantly less than in Group 10RL (p=0.02).

Discussion: Preloading 20 mL/kg of RL prior to spinal anesthesia followed by constant ephedrine infusion of 3 mg/min after spinal block delayed hypotension, required less ephedrine for treatment of hypotension and provided better 1 min Apgar scores without changing cord blood analysis during elective C/S.

SOAP 2010