Prophylactic Ephedrine Infusion versus Colloid Preload in the Prevention of Spinal - Induced Hypotension in Elective Caesarean Section = مقارنة تأثير الإعطاء المسبق لعقار الأفدرين المسرب عبر السوائل الوريدية وإعطاء السوائل الغروية في الوقاية من انخفاض ضغط الدم الناتج من التخدير عبر الحقن النخاعي في العمليات القيصرية المبرمجة

Abstract

This prospective experimental cohort study was conducted in Khartoum and Khartoum North Teaching Hospitals, in the period from March to June 2011, aiming to assess the efficacy of preloading parturients, undergoing elective caesarean section, with hydroxy ethyl starch 6% (HES 6%) compared to ephedrine infusion in the prevention of spinal anaesthesia induced hypotension. Methods: In this study, 100 healthy American Society of Anesthesiologist physical status classification system grade I or II, parturients undergoing elective caesarean section, received a preload of either ephedrine 30 mg in 500 ml normal saline (Group A=50 parturients) or HES 6% 1000 ml (Group B=50 parturients), 1530 min before spinal anesthesia. The incidence of intraoperative hypotension, the amount of additional normal saline and ephedrine needed to treat hypotension and the incidence of spinal related complications were compared in both groups. Neonatal outcome was assessed and recorded using the Apgar score. Results: Both ephedrine in normal saline infusion and HES 6%, administered before spinal anaesthesia, significantly reduced the incidence of spinal induced hypotension. The incidence of nausea, vomiting and lightheadedness were significantly more in parturients who received ephedrine with normal saline preload, compared to those who received HES 6%. Hydroxy ethyl starch 6% offer more (although insignificant) haemodynamic stability compared to ephedrine infusion. The neonatal outcome, assessed by Apgar scores at 1 and 5 min, was normal in both study groups. Conclusion: Preventive strategies should be a routine, as a drop in blood pressure is always expected following spinal anaesthesia. Use of HES 6% preload seems to be superior to ephedrine or crystalloid solutions regarding intraoperative haemodynamic stability and spinal anaesthesia related complications. Both study solutions have no deleterious effects on neonatal outcome.