Prophylactic Intravenous Bolus Ephedrine for Elective Caesarean Section Under Spinal Anesthesia

Abstract

Objective : To evaluate the efficacy and optimal dose of prophylactic intravenous ephedrine tor the prevention of maternal hypotension associated with spinal anesthesia for Caesarean section.

Methods : After patients had received an intravenous preload of 15 ml/kg of Iactated Ringer’s solution, spinal anesthesia was administered in the right lateral decubitus position with 0.5% hyperbaric bupivacaine 1.8 ml combined with 200 mcg morphine. A total of 90 patients were randomized to receive a simultaneous 2 ml bolus intravenously of either 0.9% saline (Group C, n = 30), ephedrine 5 mg (Group E-5, n = 30) or ephedrine 10 mg (Group E-10, n = 30). Further rescue boluses of ephedrine 5 mg were given if systolic arterial pressure tall below 90 mmHg, greater than 20% below baseline or if symptoms suggestive of hypotension were reported.

Results : There were no significant differences in the incidence of hypotension (53.67% vs 33.33%, 36.63%) p > 0.05, nausea or vomiting between groups. Rebound hypertension were not observed and there were no significant differences in Apgar scores. Less rescue doses of ephedrine were required in Group E-5, E-10 compare with the control group (0.83 ±1.23 vs 1.73 ± 1.81, 0.70 ± 1.19 vs 1.73 ± 1.81, p < 0.05).

Conclusion : Intravenous bolus ephedrine 5, 10 mg could not prevent or reduce incidence of hypotension in parturients received spinal anesthesia for cesarean delivery but less rescue doses of ephedrine were required in Group E-5, E-10 compare with the control group.