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Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine

BACKGROUND: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia....

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Autores principales: Kulkarni, Kalpana Rajendra, Naik, Amruta Girish, Deshpande, Sunetra Girish
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062204/
https://www.ncbi.nlm.nih.gov/pubmed/27746565
http://dx.doi.org/10.4103/0259-1162.191118
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author Kulkarni, Kalpana Rajendra
Naik, Amruta Girish
Deshpande, Sunetra Girish
author_facet Kulkarni, Kalpana Rajendra
Naik, Amruta Girish
Deshpande, Sunetra Girish
author_sort Kulkarni, Kalpana Rajendra
collection PubMed
description BACKGROUND: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia. AIMS: We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section. METHODS: A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P < 0.05 was considered as significant. RESULTS: Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to group P (58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in group P delivered babies. CONCLUSION: Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery.
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spelling pubmed-50622042016-10-14 Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine Kulkarni, Kalpana Rajendra Naik, Amruta Girish Deshpande, Sunetra Girish Anesth Essays Res Original Article BACKGROUND: Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia. AIMS: We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section. METHODS: A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to group P (n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied and P < 0.05 was considered as significant. RESULTS: Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to group P (58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in group P delivered babies. CONCLUSION: Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC5062204/ /pubmed/27746565 http://dx.doi.org/10.4103/0259-1162.191118 Text en Copyright: © Anesthesia: Essays and Researches http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kulkarni, Kalpana Rajendra
Naik, Amruta Girish
Deshpande, Sunetra Girish
Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title_full Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title_fullStr Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title_full_unstemmed Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title_short Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine
title_sort evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: rapid crystalloid hydration versus intravenous ephedrine
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062204/
https://www.ncbi.nlm.nih.gov/pubmed/27746565
http://dx.doi.org/10.4103/0259-1162.191118
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