The role of Intramuscular Ephedrine, Intravenous Ephedrine and Intravenous Atropine in prevention of hypotension resulting from spinal anesthesia in patients with cesarean section

Background: Most of cesarean deliveries are performed with regional anesthesia especially spinal anesthesia (SA). Disadvantages of SA include maternal hypotension and fetal asphyxia. This study was conducted to find prophylactic strategies for prevention of maternal hypotension in the women who were candidate for cesarean in Rasht Azzahra Hospital in ۲۰۰۱. Materials and Methods: This study was a double blind randomized clinical trial that was done on ۹۶ women who were candidate for elective cesarean section. The patients were randomly divided into four groups (۲۴ patients in each group). They received either Saline (control), intramuscular Ephedrine ۳۰ mg [IME] ۱۵ minutes before SA, intravenous Ephedrine ۳۰ mg [IVE] one minute after SA and intravenous Atropine ۰.۵ mg [IVA] one minute after SA. Blood pressure, pulse rate (PR) and SaO۲ were determined before SA and then with ۳ – ۵- minute intervals until ۴۰ minutes after SA. Severe hypotension was defined as more than ۳۰% decrease in systolic blood pressure or less than ۹۰ mmHg in patients with normal blood pressure. SA was done with ۵% Lidocaine. Statistical analysis was done using Chi-square test and variance analysis. Results: The prevalence of severe hypotension was ۲۱% in IME, ۱۷% in IVE and ۳۷.۵% in IVA and ۴۲% in control group. Their difference was statistically significant only in IVE (P<۰.۰۵). IME group had more tachycardia than other groups probably due to higher prevalence of mild hypotension. Ephedrine IV had not any adverse effect on maternal PR, neonatal PR and APGAR score. Conclusion: Prophylactic administration of Ephedrine ۳۰ mg IV during one minute after SA is useful for the prevention of severe hypotension in cesarean deliveries and these patients had more hemodynamic stability. Administration of this drug had not any adverse effect on maternal PR, neonatal PR and APGAR score.

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KEYWORDS: Atropine , Ephedrine , Spinal anesthesia , Cesarean section , Hypotension , واژگای کلیدی: آتروپین , افدرین , بی حسی نخاعی , سزارین , فشار خون