Effects of Ephedrine Infusion for the Prevention of Hypotension during Spinal Anesthesia for Elective LSCS

Abstract

Spinal anesthesia provides a fast, profound and symmetrical sensory and motor blockade of high quality in patients undergoing LSCS. However, the most common serious adverse effect of spinal anesthesia for LSCS is hypotension. Maternal hypotension has detrimental effects on uterine blood flow causing fetal hypoxia and acidosis. Preloading with crystalloids and use of vasopressors is widely recommended to prevent hypotension. We designed a study to determine the effects of ephedrine infusion for control of hypotension in women undergoing elective LSCS. In this observational study 80 parturients in the age group of 20 to 40 years, posted for elective caesarean section and belonging to ASA class 1 and 2 were selected. After preloading with 500 ml of ringer lactate solution, all the patients received spinal anaesthesia with 2ml inj.bupivacaine 0.5% (heavy). Immediately after institution of subarachnoid block the infusion of ephedrine at the rate of 1.25 mg/min via an infusion pump was started and was continued till clamping of the umbilical cord. The incidence of hypotension was 11% which was found to be lower when compared with other studies. Average dose of ephedrine used was 17±2 mg. Average APGAR score in our study were found to be 8 and 9 at 1 and 5 minutes. No neonate had an APGAR score below 7. The incidence of nausea and vomiting was 6% and that of reactive hypertension was 2%. None of the patients had tachycardia, bradycardia or shivering. We concluded that, prophylactic intra-venous ephedrine infusion immediately after spinal anesthesia is a quick, simple, safe and effective technique in preventing hypotension without unwanted side effects such as nausea, vomiting and hypertension in women posted for elective LSCS and can be of great value in routine practice. Being an observation study, comparison with a control group is recommended for comments on efficacy.