Prophylactic intravenous bolus ephedrine for elective Caesarean section under spinal anaesthesia
作者:
J. Loughrey,
F. Walsh,
J. Gardiner,
期刊:
European Journal of Anaesthesiology
(OVID Available online 2002)
卷期:
Volume 19,
issue 1
页码: 63-68
ISSN:0265-0215
年代: 2002
出版商: OVID
关键词: ANAESTHESIA, spinal;CARDIOVASCULAR AGENTS, vasoconstrictor agents, ephedrine;OBSTETRIC SURGICAL PROCEDURES, delivery, Caesarean section
数据来源: OVID
摘要:
Background and objective:To evaluate the efficacy and optimal dose of prophylactic intravenous ephedrine for the prevention of maternal hypotension associated with spinal anaesthesia for Caesarean section.Methods:After patients had received an intravenous preload of 0.5 L of lactated Ringer's solution, spinal anaesthesia was administered in the sitting position with hyperbaric bupivacaine 2.5 mL 0.5% combined with 25 μg fentanyl. A total of 68 patients were randomized to receive a simultaneous 2 mL bolus intravenously of either 0.9% saline (Group C,n= 20), ephedrine 6 mg (Group E-6,n= 24), or ephedrine 12 mg (Group E-12,n= 22). Further rescue boluses of ephedrine 6 mg were given if systolic arterial pressure fell to below 90 mmHg, greater than 30% below baseline, or if symptoms suggestive of hypotension were reported.Results:There was a significantly higher incidence of hypotension in Group C (60% patients) compared to Group E-12 (27%), but not in Group E-6 (50%). The 95% Confidence Interval for the difference in proportions between Groups C and E-12 was 6-60%,P< 0.05. Fewer rescue boluses of ephedrine were required in Group E-12 compared with Group C (1.8 ± 1.2 vs. 3.3 ± 2.1,P< 0.05). There were no significant differences in the incidence of maternal nausea or vomiting, or of neonatal acidaemia between groups.Conclusion:A prophylactic bolus of ephedrine 12 mg intravenously given at the time of intrathecal block, plus rescue boluses, leads to a lower incidence of hypotension following spinal anaesthesia for elective Caesarean section compared to intravenous rescue boluses alone.
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