Crystalloid Preloading versus Prophylactic Ephedrine Infusion for Prevention of Hypotension during Caesarean Section

Abstract

Context: Central neuraxial blockade is widely practiced in obstetric anesthesia. The prevention of maternal systemic hypotension is of importance. Aim: To compare between crystalloid preloading and prophylactic intravenous ephedrine in the prevention of maternal systemic hypotension after spinal anesthesia for cesarean section. Settings and Design: Study was conducted in a tertiary care hospital; comparative observational study. Methods and Materials: One hundred fifty six healthy parturients, posted for elective cesarean section. The parturients who were preloaded with 10 mL/kg of Ringer Lactate over 20 minutes before spinal anesthesia by treating anesthesiologist were included in Group P. Parturients were administered prophylactic ephedrine 0.125 mg/kg infusion after spinal anesthesia at the onset of sympathetic block by treating anesthesiologist were included in Group E. Statistical Analysis Used: Data were entered in Microsoft excel and analyzed using SPSS software version 25 (IBM). Results: In our study, we found that fall in blood pressure was statistically significant from fourth to 14th minute in Group P compared to Group E. The mean arterial pressure became significantly low in Group P compared to Group E. Heart rate was found to increase in Group P from second minute compared to sixth minute in Group E. Fetal wellbeing assessed by appearance (colour), pulse, grimace (response to touch), activity (tone) and respiration (APGAR) score was better in Group E compared to Group P and was statistically significant. Nausea and vomiting were more in Group P compared to Group E and was statistically significant. Conclusions: We conclude that prophylactic ephedrine infusion has better control over maternal hemodynamic than crystalloid preloading in cesarean section under spinal anesthesia.