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A sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia.
Int J Obstet Anesth 2012; 21(2):140-5IJ

Abstract

BACKGROUND

Spinal anesthesia is a standard technique for cesarean section but can cause hypotension which may be related to venous pooling secondary to progesterone-induced decreases in vascular tone. This study investigated the use of a sequential compression mechanical pump with thigh-high sleeves with compression cycles timed to venous refilling. We hypothesized that this would recruit pooled venous blood from the lower limbs, maintain the central blood volume and thus decrease the incidence of hypotension.

METHODS

One hundred parturients scheduled for elective cesarean section under spinal anesthesia were recruited and randomly assigned to use of either a mechanical pump (Group M) or control (Group C). A standardized protocol for co-hydration and anesthesia was followed. Hypotension, defined as a decrease in systolic blood pressure by >20% from baseline, was treated with 6-mg boluses of intravenous ephedrine. The incidence of hypotension was defined as the primary outcome. Median ephedrine requirement was taken as a measure of the severity of hypotension.

RESULTS

Hypotension occurred in 12 of 47 (25.5%) patients in Group M compared to 27 of 45 (60%) in Group C (P=0.001). The median [range] ephedrine dose was greater in Group C (12 [0-24]mg) compared to Group M (0 [0-12]mg) (P<0.001). There was no difference between groups in the time to onset of hypotension.

CONCLUSION

The use of a sequential compression mechanical pump that detects venous refilling and cycles accordingly, reduced the incidence and severity of hypotension after spinal anesthesia for cesarean section.

Authors+Show Affiliations

Department of Anesthesia, Max Super Speciality Hospital, New Delhi, India. drnambiath@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

22398360

Citation

Sujata, N, et al. "A Sequential Compression Mechanical Pump to Prevent Hypotension During Elective Cesarean Section Under Spinal Anesthesia." International Journal of Obstetric Anesthesia, vol. 21, no. 2, 2012, pp. 140-5.
Sujata N, Arora D, Panigrahi BP, et al. A sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia. Int J Obstet Anesth. 2012;21(2):140-5.
Sujata, N., Arora, D., Panigrahi, B. P., & Hanjoora, V. M. (2012). A sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia. International Journal of Obstetric Anesthesia, 21(2), pp. 140-5. doi:10.1016/j.ijoa.2012.01.003.
Sujata N, et al. A Sequential Compression Mechanical Pump to Prevent Hypotension During Elective Cesarean Section Under Spinal Anesthesia. Int J Obstet Anesth. 2012;21(2):140-5. PubMed PMID: 22398360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia. AU - Sujata,N, AU - Arora,D, AU - Panigrahi,B P, AU - Hanjoora,V M, Y1 - 2012/03/06/ PY - 2011/04/03/received PY - 2012/01/14/revised PY - 2012/01/24/accepted PY - 2012/3/9/entrez PY - 2012/3/9/pubmed PY - 2012/8/30/medline SP - 140 EP - 5 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 21 IS - 2 N2 - BACKGROUND: Spinal anesthesia is a standard technique for cesarean section but can cause hypotension which may be related to venous pooling secondary to progesterone-induced decreases in vascular tone. This study investigated the use of a sequential compression mechanical pump with thigh-high sleeves with compression cycles timed to venous refilling. We hypothesized that this would recruit pooled venous blood from the lower limbs, maintain the central blood volume and thus decrease the incidence of hypotension. METHODS: One hundred parturients scheduled for elective cesarean section under spinal anesthesia were recruited and randomly assigned to use of either a mechanical pump (Group M) or control (Group C). A standardized protocol for co-hydration and anesthesia was followed. Hypotension, defined as a decrease in systolic blood pressure by >20% from baseline, was treated with 6-mg boluses of intravenous ephedrine. The incidence of hypotension was defined as the primary outcome. Median ephedrine requirement was taken as a measure of the severity of hypotension. RESULTS: Hypotension occurred in 12 of 47 (25.5%) patients in Group M compared to 27 of 45 (60%) in Group C (P=0.001). The median [range] ephedrine dose was greater in Group C (12 [0-24]mg) compared to Group M (0 [0-12]mg) (P<0.001). There was no difference between groups in the time to onset of hypotension. CONCLUSION: The use of a sequential compression mechanical pump that detects venous refilling and cycles accordingly, reduced the incidence and severity of hypotension after spinal anesthesia for cesarean section. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/22398360/A_sequential_compression_mechanical_pump_to_prevent_hypotension_during_elective_cesarean_section_under_spinal_anesthesia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(12)00005-2 DB - PRIME DP - Unbound Medicine ER -