Hemodynamic Effects during Combined Spinal and Epidural Anesthesia: Role of Fluid Preloading and Prophylactic Vasoconstrictors

Abstract

The most common complication encountered with combined spinal and epidural anaesthesia is hypotension. Several interventions can be planned for prevention of hypotension after combined spinal and epidural anaesthesia. We compare fluid preloading with prophylactic vasoconstrictors (Ephedrine) in reducing the hemodynamic side effects of combined spinal and epidural anaesthesia. The study was carried out randomly on 60 patients in age group of 20 –65 yrs. Patients classified under class 1-3 as per ASA classification. Patients were randomly allocated to the two groups. GROUP-1 patients had received crystalloid preloading (Ringer Lactate) 20 minute before procedure at a rate of 15ml /kg and GROUP-2 patients had received prophylactic ephedrine intravenously 5mg, 5mg at 1 and 2 minute and 1mg at every minute thereafter for 15 minutes after block. HR, BP were recorded immediately after placing patient in supine position and then at 5, 10, 15, 20, 25, 30, 45, 60, 90, 120 minutes. Minute to minute monitoring was done to assess any haemo-dynamic changes and early institution of corrective therapy. In both Group 1 and Group 2 sustained fall in systolic blood pressure was observed from baseline. In Group 1 the fall in BP was more and the difference was also statistically significant. There were comparable sequential rise in mean pulse rate in both the groups, although this was statistically non-significant. In Group 1 nine patients showed hypotension out of which four (44.5%) were managed with fluid challenge alone and rest five patients needed ephedrine. There were three hypotensive patients in Group 2; two out of them (66%) were managed by i.v. fluid boluses alone. Study showed that vasoconstrictor (ephedrine) is a more effective method in reducing the incidence and severity of fall in systolic blood pressure as compared to volume preloading.