Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study

Soltani, Hassan Ali; Hashemi, Jalal; Behdad, Shekoofe; Soleimani, Behzad

doi:10.4103/2277-9175.100129

Cited by 16 publications

(16 citation statements)

References 21 publications

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“…However, the use of crystalloid preload with ephedrine bolus was found to be more effective in reducing the incidence of hypotension. [ 21 ] Bhardwaj et al . compared bolus dose (E = 5 mg, M = 0.5 mg, P = 30 µg) followed by infusion (E = 2.5 mg/min, M = 0.25 mg/min, P = 15 µg/min) with ephedrine, metaraminol, phenylephrine, respectively, and observed maternal hemodynamics, umbilical blood gases, and complications.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

2016

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Background:Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia.Aims:We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section.Methods:A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P < 0.05 was considered as significant.Results:Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to group P (58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in group P delivered babies.Conclusion:Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery.

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Section: Discussionmentioning

confidence: 99%

Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

2016

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“…Hypotension is defined as a fall greater than 30% in baseline levels, and bradycardia is defined as a heart rate of less than 60 beats/min. The administration of a high volume of crystalloid solution, placement of the patient in the Trendelenburg position, and administration of intravenous ephedrine and atropine are used to reduce hypotension ( 18 ). In the present study, no significant hemodynamic disorders occurred in the unilateral spinal anesthesia group (Group S).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial

Kiasari¹,

Babaei²,

Alipour³

et al. 2017

Med Arch

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Background:Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries.Materials and Methods:In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery.Results:SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively).Conclusion:Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia.

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“…[ 19 ] Moreover, other study showed that integration of precautionary methods would be necessary for reducing hypotension following spinal anesthesia for the elective cesarean section and they mentioned to giving preloading with ephedrine as the best method. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia

Saghafinia¹,

Jalali²,

Eskandari³

et al. 2017

Adv Biomed Res

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Background:Hypotension is one of the most common complications after spinal anesthesia for cesarean delivery. Normally, preloading with fluids, especially crystalloids, is used to prevention of hypotension.Methods:In the present randomized clinical trial study, 120 parturients presenting for elective cesarean section with the American Society of Anesthesiologists Class I and II received either 15 cc normal saline or 7 cc/kg hydroxyethyl starch 6% (Voluven) fluid. Information regarding to systolic, diastolic, mean arterial pressure, and heart rate, incidence of hypotension, adverse effects, the total dose of atropine, and ephedrine were recorded in before and 3, 6, 9, 15, and 20 min after spinal anesthesia. Furthermore, Apgar score of newborn at the 1st and 5th min after birth was recorded.Results:There was no significant difference in mean arterial pressure at different stages such as: Exactly after spinal and 3, 6, 15, and 20 min after spinal anesthesia between two groups (P > 0.05). Total dose of ephedrine and atropine were similar between groups (P > 0.05), respectively. There was no significant difference in Apgar score at the 1st and 5th min after birth between two groups. There were not any adverse effects of drugs in two groups.Conclusions:The results of this study show that hydroxyethyl starch 6% compared to normal saline are similar to prevent hypotension during spinal anesthesia for cesarean delivery.

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Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study

Cited by 16 publications

References 21 publications

Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial

The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia

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