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Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients.
Anesth Analg 2000; 90(2):324-7A&A

Abstract

To evaluate the effectiveness of prophylactic ephedrine for the prevention of hypotension associated with spinal anesthesia, 50 parturients undergoing cesarean delivery received either ephedrine 5 mg or saline IV in a double-blinded fashion immediately after the induction of spinal anesthesia. Spinal anesthesia was performed with hyperbaric bupivacaine 6.6 mg combined with sufentanil 3.3 microg as part of a combined spinal-epidural technique. All patients received 1000 mL of lactated Ringer's solution and 500 mL of hydroxyethylstarch 6% before the spinal injection. Additional ephedrine boluses (5 mg) were administered IV when the systolic blood pressure or heart rate decreased by more than 30% from baseline values, when systolic blood pressure became <100 mm Hg, or when patients complained of nausea or feeling faint. The height of the block was equal in the groups; however, more patients in the placebo group were found to develop hypotension (58% vs 25%, P < 0. 05). Only 2 (8%) patients in the ephedrine group developed hypotension with systolic blood pressure values <90 mm Hg, whereas 10 patients (42%) in the saline group experienced hypotension of this severity (P < 0.05). In addition, there was a higher incidence of nausea in the placebo-treated patients. The total amount of ephedrine administered did not differ between groups. These findings suggest that the incidence and severity of hypotension are significantly reduced by the IV administration of a prophylactic dose of 5 mg ephedrine in patients receiving small-dose spinal anesthesia for cesarean delivery.

IMPLICATIONS

Ephedrine is the drug most often used to correct hypotension during spinal anesthesia for cesarean delivery in healthy patients. A single IV dose of 5 mg decreases the occurrence and limits the severity of hypotension in prehydrated subjects receiving a small-dose spinal local anesthetic-opioid combination.

Authors+Show Affiliations

Department of Anesthesiology, University Hospital Antwerp, Edegem, Belgium. vercauteren@uza.uia.ac.beNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

10648315

Citation

Vercauteren, M P., et al. "Prevention of Hypotension By a Single 5-mg Dose of Ephedrine During Small-dose Spinal Anesthesia in Prehydrated Cesarean Delivery Patients." Anesthesia and Analgesia, vol. 90, no. 2, 2000, pp. 324-7.
Vercauteren MP, Coppejans HC, Hoffmann VH, et al. Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. Anesth Analg. 2000;90(2):324-7.
Vercauteren, M. P., Coppejans, H. C., Hoffmann, V. H., Mertens, E., & Adriaensen, H. A. (2000). Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. Anesthesia and Analgesia, 90(2), pp. 324-7.
Vercauteren MP, et al. Prevention of Hypotension By a Single 5-mg Dose of Ephedrine During Small-dose Spinal Anesthesia in Prehydrated Cesarean Delivery Patients. Anesth Analg. 2000;90(2):324-7. PubMed PMID: 10648315.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. AU - Vercauteren,M P, AU - Coppejans,H C, AU - Hoffmann,V H, AU - Mertens,E, AU - Adriaensen,H A, PY - 2000/1/29/pubmed PY - 2000/3/4/medline PY - 2000/1/29/entrez SP - 324 EP - 7 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 90 IS - 2 N2 - UNLABELLED: To evaluate the effectiveness of prophylactic ephedrine for the prevention of hypotension associated with spinal anesthesia, 50 parturients undergoing cesarean delivery received either ephedrine 5 mg or saline IV in a double-blinded fashion immediately after the induction of spinal anesthesia. Spinal anesthesia was performed with hyperbaric bupivacaine 6.6 mg combined with sufentanil 3.3 microg as part of a combined spinal-epidural technique. All patients received 1000 mL of lactated Ringer's solution and 500 mL of hydroxyethylstarch 6% before the spinal injection. Additional ephedrine boluses (5 mg) were administered IV when the systolic blood pressure or heart rate decreased by more than 30% from baseline values, when systolic blood pressure became <100 mm Hg, or when patients complained of nausea or feeling faint. The height of the block was equal in the groups; however, more patients in the placebo group were found to develop hypotension (58% vs 25%, P < 0. 05). Only 2 (8%) patients in the ephedrine group developed hypotension with systolic blood pressure values <90 mm Hg, whereas 10 patients (42%) in the saline group experienced hypotension of this severity (P < 0.05). In addition, there was a higher incidence of nausea in the placebo-treated patients. The total amount of ephedrine administered did not differ between groups. These findings suggest that the incidence and severity of hypotension are significantly reduced by the IV administration of a prophylactic dose of 5 mg ephedrine in patients receiving small-dose spinal anesthesia for cesarean delivery. IMPLICATIONS: Ephedrine is the drug most often used to correct hypotension during spinal anesthesia for cesarean delivery in healthy patients. A single IV dose of 5 mg decreases the occurrence and limits the severity of hypotension in prehydrated subjects receiving a small-dose spinal local anesthetic-opioid combination. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/10648315/Prevention_of_hypotension_by_a_single_5_mg_dose_of_ephedrine_during_small_dose_spinal_anesthesia_in_prehydrated_cesarean_delivery_patients_ L2 - http://dx.doi.org/10.1097/00000539-200002000-00016 DB - PRIME DP - Unbound Medicine ER -