Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study

Mitra Jabalameli, Hassan Ali Soltani, Jalal Hashemi, Shekoofe Behdad, Bahram Soleimani, Mitra Jabalameli, Hassan Ali Soltani, Jalal Hashemi, Shekoofe Behdad, Bahram Soleimani

Abstract

Background: The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia.

Materials and methods: In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer's Lactate (RL) solution (15 ml/kg) plus Hemaxel (7 ml/kg) preload, 2---RL solution (15 ml/kg) preload plus ephedrine (15 mg, IV, bolus), 3---Hemaxel (7 ml/kg) preload plus ephedrine (15 mg, IV, bolus). Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups.

Results: The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH.

Conclusion: Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.

Keywords: Cesarean delivery; hypotension; spinal anesthesia.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Flow diagram of endrolled study patients
Figure 2
Figure 2
Blood Pressure changes during 60 min after spinal injection. Group 1: crystalloid + colloid. Group 2: crystalloid + ephedrine. Group 3: colloid + ephedrine. P

Figure 3

Heart rate changes during 60…

Figure 3

Heart rate changes during 60 minutes after spinal injection. Group 1: crystalloid +…

Figure 3
Heart rate changes during 60 minutes after spinal injection. Group 1: crystalloid + colloid. Group 2: crystalloid + ephedrine. Group 3: colloid + ephedrine. P
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References
    1. Kuczkopwski KM, Reisner LS, Lin D. Anesthesia for cesarean section. In: Chestnut DH, Polley LS, Tsen LC, Wong CA, editors. Chestnut's Obstetric Anesthesia: Principles and Practice. 4th ed. Philadelphia: Mosby; 2009. pp. 422–5.
    1. Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: Literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54:909–21. - PubMed
    1. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: A meta-analysis. Anaesthesia. 2005;60:636–53. - PubMed
    1. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;4:CD002251. - PubMed
    1. Sertznig C, Vial F, Audibert G, Mertes PM, El Adssi H, Bouaziz H. Management of hypotension during spinal anaesthesia for elective caesarean section: A survey of practice in Lorraine region] Ann Fr Anesth Reanim. 2011;30:630–5. - PubMed
Show all 25 references
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Figure 3
Figure 3
Heart rate changes during 60 minutes after spinal injection. Group 1: crystalloid + colloid. Group 2: crystalloid + ephedrine. Group 3: colloid + ephedrine. P

References

    1. Kuczkopwski KM, Reisner LS, Lin D. Anesthesia for cesarean section. In: Chestnut DH, Polley LS, Tsen LC, Wong CA, editors. Chestnut's Obstetric Anesthesia: Principles and Practice. 4th ed. Philadelphia: Mosby; 2009. pp. 422–5.
    1. Klohr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anaesthesia for caesarean section: Literature search and application to parturients. Acta Anaesthesiol Scand. 2010;54:909–21.
    1. Reynolds F, Seed PT. Anaesthesia for Caesarean section and neonatal acid-base status: A meta-analysis. Anaesthesia. 2005;60:636–53.
    1. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;4:CD002251.
    1. Sertznig C, Vial F, Audibert G, Mertes PM, El Adssi H, Bouaziz H. Management of hypotension during spinal anaesthesia for elective caesarean section: A survey of practice in Lorraine region] Ann Fr Anesth Reanim. 2011;30:630–5.
    1. Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2004;98:483–90.
    1. Mercier FJ, Bonnet MP, De la Dorie A, Moufouki M, Banu F, Hanaf A, et al. Spinal anaesthesia for caesarean section: Fluid loading,vasopressors and hypotension. Ann Fr Anesth Reanim. 2007;26:688–93.
    1. Gunusen I, Karaman S, Ertugrul V, Firat V. Effects of fluid preload (crystalloid or colloid) compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anaesthesia for caesarean delivery. Anaesth Intensive Care. 2010;38:647–53.
    1. Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: A qualitative systematic review. Anesth Analg. 2001;92:997–1005.
    1. Mathru M, Rao TL, Kartha RK, Shanmugham M, Jacobs HK. Intravenous albumin administration for prevention of spinal hypotension during cesarean section. Anesth Analg. 1980;59:655–8.
    1. Riley ET, Cohen SE, Rubenstein AJ, Flanagan B. Prevention of hypotension after spinal anesthesia for cesarean section: Six percent hetastarch versus lactated Ringer's solution. Anesth Analg. 1995;81:838–42.
    1. Vercauteren MP, Coppejans HC, Hoffmann VH, Mertens E, Adriaensen HA. Prevention of hypotension by a single 5-mg dose of ephedrine during small-dose spinal anesthesia in prehydrated cesarean delivery patients. Anesth Analg. 2000;90:324–7.
    1. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103:744–50.
    1. Faydaci F, Gunaydin B. Different preloading protocols with constant ephedrine infusion in the prevention of hypotension for elective cesarean section under spinal anesthesia. Acta Anaesthesiol Belg. 2011;62:5–10.
    1. Osseyran Samper F, Errando CL, Plaza Lloret M, Díaz Cambronero O, García Gregorio N, de Andrés Ibáñez J. Prophylaxis for hypotension during cesarean section under spinal anesthesia: A randomized trial comparing hydroxyethyl starch 130/0.4 to ephedrine. Rev Esp Anestesiol Reanim. 2011;58:17–24.
    1. Mercier FJ. Prevention and treatment of hypotension during spinal anesthesia for elective caesarean section: Any progress in clinical practice? Ann Fr Anesth Reanim. 2011;30:622–4.
    1. Ko JS, Kim CS, Cho HS, Choi DH. A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery. Int J Obstet Anesth. 2007;16:8–12.
    1. Adsumelli RS, Steinberg ES, Schabel JE. Sequential compression device with thigh-high sleeves supports mean arterial pressure during cesarean section under spinal anesthesia. Br J Anaesth. 2003;91:695–8.
    1. Rout CC, Rocke DA. Prevention of hypotension following spinal anesthesia for cesarean section. Int Anesthesiol Clin. 1994;32:117–35.
    1. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension during spinal anesthesia for cesarean delivery: An effective technique using combination phenylephrine infusion and crystalloid cohydration. Anesthesiology. 2005;103:744–50.
    1. Lee A, Ngan Kee WD, Gin T. Prophylactic ephedrine prevents hypotension during spinal anesthesia for Cesarean delivery but does not improve neonatal outcome: A quantitative systematic review. Can J Anaesth. 2002;49:588–99.
    1. Simon L, Provenchère S, de Saint Blanquat L, Boulay G, Hamza J. Dose of prophylactic intravenous ephedrine during spinal anesthesia for cesarean section. J Clin Anesth. 2001;13:366–9.
    1. Moss J, Glick D. The autonomic nervous system. In: Miller RD, Fleisher LA, Johns RA, Savarese JJ, Wiener-Kronish JP, Young WL, editors. Miller's Anesthesia. Philadelphia: Churchil Livingstone; 2005. p. 650.
    1. Dahlgren G, Granath F, Wessel H, Irestedt L. Prediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload. Int J Obstet Anesth. 2007;16:128–34.
    1. Webb AA, Shipton EA. Re-evaluation of i.m. ephedrine as prophylaxis against hypotension associated with spinal anaesthesia for Caesarean section. Can J Anaesth. 1998;45:367–9.

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