Effect of prophylactic ephedrine on blood pressure changes during cesarean section under spinal anesthesia at Tikur Anbesa specialized hospital, Ethiopia, 2018: prospective cohort study

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2018-05

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Addis Ababa Universty

Abstract

Introduction: Spinal anesthesia is commonly used for caesarean section; however hypotension is a common clinical problem after spinal anesthesia. Prophylaxis Ephedrine can be used as an alternative to decrease this problem. Ephedrine can safely be administered by bolus IV route which is simple and cheap, because of its longer duration of action than other vasopressors. Objective: The objective of this study is to determine the effect of prophylactic ephedrine on blood pressure changes after spinal anesthesia during elective cesarean section at Tikur Anbessa Specialized Hospital (TASH), 2018. Materials and Methods: This institutional based Prospective observational cohort study used systematic random sampling to randomly select a total of 88 parturients scheduled for elective cesarean section under spinal anesthesia with 1:1 ratio. Patients in prophylactic group received prophylactic intravenous ephedrine (10mg) while the non-prophylactic group patients received fluid coloading only. Comparisons of numerical variables between study groups were done using unpaired student t- test for symmetric data and Manny Whitney U test for asymmetric data. For categorical variable statistical difference between groups were tested using Chi square. The first hypotension incidence time between groups were analyzed by Kaplan-Meier survival analysis using the log-rank test. Significance was determined at P value <0.05. The results are presented by using text, table‟s, charts and graphs. Results: Hypotension occurred in 50% of patients in non-prophylactic group and in 22.7% of patients in prophylactic group [X2(1, N=88) = 7.07, P= 0.008]. Prophylactic group had higher mean values of systolic and diastolic blood pressure starting from 5th minute until the 20th minute after induction than the non-prophylactic group (P < 0.05). The first hypotension incidence time, number of patient that required rescue vasopressor, total dose of rescue vasopressor and incidence of Nausea were significantly different between the groups. Differences in heart rate between groups were not statistically significant. Conclusion: Combination of coloading of fluid with prophylactic 10 mg bolus ephedrine reduced the occurrence of hypotension and greater hemodynamic stability was achieved following spinal anesthesia in parturient undergoing cesarean delivery.

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Spinal anesthesia

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