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Abstract: Spinal anesthesia is a common method of anesthesia in cesarean section and hypotension is the most
common side effect of this method. The aim of this study is comparison between effects of ephedrine and distilled
water on hypotension in patients under elective cesarean section with spinal anesthesia. This randomized clinical
trial study included patients scheduled for elective cesarean section under spinal anesthesia. In this study 82 patients
divided into two groups and they were injected subcutaneously randomly with 10 mg ephedrine (2 cc) or distilled
water (2 cc). The patients hydrated 10-20 cc/kg before spinal anesthesia. After installation of cardiac lids and pulse
oximetry, their blood pressure measured and recorded in 5 min before and 5, 10, 15, 30 min after spinal anesthesia.
The Patients were received intravenous ephedrine if hypotension (hypotension was enumerated in blood pressure
less than 90/60 mm Hg) was occurred. Diastolic hypotension was significantly occurred in ephedrine group was less
than distilled water group in 30 min after spinal anesthesia (P=0.046), but there was no significant difference
between two groups in other earlier times. Prophylactic subcutaneous injection of ephedrine can effectively prevent
diastolic hypotension after spinal anesthesia.
[Ghanei M, Sahraei R Jahromi AS. The Prevention Of Systemic Hypotension In Caesarean Section By
Subcutaneous Injection Of Ephedrine Before Spinal Anesthesia. Life Sci J 2014,11(6):320-322] (ISSN:1097-
8135). http://www.lifesciencesite.com. 43
Table-1: systolic blood pressure in ephedrine (study) and sterile distilled water (control) groups.
group S BP 5 min S BP 5 min after S BP 10 min S BP 15 min S BP 30 min
before SA * SA * after SA * after SA * after SA *
Study 126.3± 108.4±20.1 110.0± 105.8±16.9 107.3±12.1
16.2 14.9
control 121.1± 107.5±16.3 108.1± 103.2±13.7 102.8±14.1
13.3 17.0
P > 0.05 >0.05 >0.05 >0.05 0.046
value
*Mean ± SD, S BP: Systolic Blood Pressure, SA: Spinal Anesthesia
Table-2: Diastolic blood pressure in ephedrine (Study) and sterile distilled water (Control) groups
group D BP 5 min D BP 5 min D BP 10 min D BP 15 min D BP 30 min
before SA * after SA * after SA * after SA * after SA *
Study 76.8±13.7 65.1±14.8 62.2±13.8 58.4±12.4 61.5±12.3
control 77.0±10.6 65.4±13.6 62.4±11.9 57.9±14.7 56.9±13.0
P value > 0.05 >0.05 >0.05 >0.05 >0.05
*Mean ± SD, D BP: Diastolic Blood Pressure, SA: Spinal Anesthesia
Clinical data have recommended that α- Anesthesia & Analgesia. 2005; 101(3): 869-
adrenergic agonists, for example ephedrine may be 875.
given safely for prevention or treatment of 3-Visalyaputra S. Is Ephedrinethe Best Vasopressor
hypotension during spinal anesthesia for cesarean for Treating Spinal Anesthesia-Induced
section (Chestnut 2009, Miller et al., 2010, Lee et al., Hypotension in Patients with Pre-Eclampsia?
2002). Anesthesia & Analgesia. 2006; 103(6): 1584-
Despite of the result of present study 1585.
indicating ephedrine can prevent systolic hypotension 4- Miceael H A, William E. Effect of Anesthetic
induced-spinal anesthesia, it is not administer Structure on Inhalation Anesthesia:
vasopressors as prophylaxis, Because: It is not Implications for the Mechanism: 2007;2373-
morally right; for instance it couldn’t be administered 2375
ephedrine to a patient had tachycardia, and also, 5- Ayorinde B, Buczkowski P, Brown J, Shah J,
previous clinical studies have not supported the Buggy D. Evaluation of pre emptive
prophylactic use of vasopressors for prevention of intramuscular phenylephrine and ephedrine for
hypotension induced-spinal anesthesia (Chestnut reduction of spinal anaesthesia induced
2009, Miller et al., Ngan et al., 2005, Thomas et al., hypotension during Caesarean section. British
1996). journal of anaesthesia. 2001; 86(3): 372-376.
The results of this study, shows that 6- Manuchehrian N, Nikooseresht M, Seif MA. The
ephedrine can prevent systolic hypotension following effect of prophylactic ephedrine to prevention
spinal anesthesia in patients undergoing cesarean of hypotension after spinal anesthesia in
section. cesarean section. Journal of hamedan medical
Further clinical trial studies are university; 2009;15(4);31-33.
recommended for treatment and prophylaxis of 7. Chestnut, D.H. (2009) Chestnut’s obstetric
hypotension induced-spinal anesthesia in women anesthesia principles and practice. 4th Editon,
undergoing cesarean section. Mosby, Philadelphia.
8. Lee, A., Ngan Kee, W.D. and Gin, T. (2002) A
Acknowledgements: Quantita- tive, systematic review of randomized
This research work was financed by Jahrom controlled trials of ephedrine versus
University of Medical Sciences. phenylephrine for the management of
hypotension during spinal anesthesia for
Corresponding Author: cesarean deli- very. Anesthesia & Analgesia,
Dr. Reza Sahraei 94, 920-926. doi:10.1097/00000539-
Department of Anesthesiology, Jahrom University of 200204000-00028
Medical Sciences, Jahrom, Iran 9. Ngan Kee, W.D., Khaw, K.S. and Ng, F.F. (2005)
E-mail: sahraeir@sums.ac.ir Pre- vention of hypotension during spinal
anesthesia for ce- sarean delivery: An effective
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3/3/2014