Comparison of an ephedrine infusion with lidocaine %5 for prevention of hypotension during spinal anesthesia in cesarean section

Abstract

Background Spinal anesthesia is the method of choice for cesarean section and in most cases causes hypotension. Objective The aim of this study was to treat hypotension by ephedrine in order to prevent maternal and fetal complications, and also to determine the effective amount of ephedrine for reducing arterial hypertension in order to prevent its complications, including cardiac arrhythmias. Method This cross-sectional descriptive study was conducted on 131 patients. Mean arterial blood pressure (MAP) of the candidates for cesarean section in the supine position was measured and recorded as mean baseline blood pressure. 75 mg of lidocaine (5%) was used as spinal anesthesia, following which the average blood pressure was measured every 1 min. In the event of a decrease in the mean arterial blood pressure of at least 20% of the mean baseline blood pressure, ephedrine 0.1/mg/kg was injected intravenously and after 1 min of MAP was measured. Result The prevalence of hypotension was 89.30%. 25.60% of patients with hypotension had 30–34.99% reduction in MAP compared to baseline MAP. 12% patients had 40% drop in their MAP. 4 min following spinal anesthesia, the incidence of hypotension reduced by 20%. The average dose of ephedrine required to reduce the incidence of hypotension was 20.5 mg. Conclusion Reduction in MAP following spinal anesthesia using lidocaine is common. Ephedrine at the dose of 20 mg is effective to reduce the incidence of perioperative hypotension.

The duration of spinal anesthesia in elective cesarean section in Trendelenburg and reverse Trendelenburg positions: a randomized clinical trial

“…In another study in this field, it has been mentioned that the use of the reverse Trendelenburg position may extend the duration of anaesthesia in patients compared to the horizontal position. However, this study did not carry out a comparative analysis between the Trendelenburg position and its reverse type 15 , 16 .…”

“…This is corroborated by a study conducted by Kumar and colleagues 14 , which described an appropriate hemodynamic status for patients in the reverse Trendelenburg position for spinal anaesthesia. In 2002, a study by Ahmad Setaayesh and colleagues compared the Trendelenburg and horizontal positions for spinal anaesthesia and found no significant differences in vital signs, arterial blood oxygen saturation, and Apgar score between the two groups 16 . It can be stated that the Trendelenburg position is a safe position concerning vital signs and hemodynamic changes 15 .…”

Hipotensão em raquianestesia durante cesariana: fatores na prevenção e manejo

“…Seu uso é mais frequente para procedimentos realizados em caráter eletivo, haja vista que em situações de emergência a indicação é que seja realizada anestesia geral, a qual apresenta alguns riscos tanto para a mãe durante a intubação, por exemplo, como para o feto em relação a passagem anestésica pela barreira placentária. Em comparação à anestesia geral, a raquianestesia permite que a mãe esteja consciente durante a realização do parto, reverberando em melhora nos índices de depressão pulmonar materna, bem como em melhores resultados fetais (POURYAGHOBI et al, 2022;ŠKLEBAR;BUJAS;HABEK, 2019).…”

“…Em virtude disso, sinais e sintomas como vômitos, redução do nível de consciência materno e diminuição do suprimento sanguíneo cerebral podem ser consequências desse cenário. Além disso, o feto também pode sofrer nessa situação, uma vez afetada a circulação pulmonar materna o concepto pode sofrer hipóxia e acidose por conta do comprometimento do fluxo sanguíneo placentário (POURYAGHOBI et al, 2022;ŠKLEBAR;BUJAS;HABEK, 2019).…”