Effectiveness of Intravenous Ephedrine Infusion during Spinal Anaesthesia for Caesarean Section Based on Maternal Hypotension, Neonatal Acid-base Status and Lactate Levels

Maternal cardiovascular changes and neonatal acid-base status, including lactate levels, were assessed in 30 healthy women undergoing elective caesarean section under spinal anaesthesia. Patients were allocated randomly to receive IV ephedrine infusion (n=15) (5 mg.min -1 ) immediately after the spinal injection or bolus administration of IV ephedrine (n=15) (10 mg) in case of development of hypotension. Maternal and neonatal blood pressure, heart rate and acid-base status including lactate levels were compared between the groups. Systolic blood pressure in the bolus group was significantly lower when compared to the infusion group. Nausea was observed in one patient (6%) in the infusion group and nausea and vomiting were observed in 10 patients (66%) in the bolus group. Although umbilical arterial pH values were significantly lower in the bolus group, lactate levels were similar. In conclusion, ephedrine infusion prevented maternal hypotension, reduced the incidence of nausea and vomiting and led to improved umbilical blood pH during spinal anaesthesia for caesarean section.

[1]  I. Russell,et al.  Volume preload: lack of effect in the prevention of spinal-induced hypotension at caesarean section. , 1998, International journal of obstetric anesthesia.

[2]  A. Vintzileos,et al.  Comparison of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation in detecting fetal acidemia at birth. , 1995, American journal of obstetrics and gynecology.

[3]  R. Jackson,et al.  Volume preloading is not essential to prevent spinal-induced hypotension at caesarean section. , 1995, British journal of anaesthesia.

[4]  P. Morgan.  The role of vasopressors in the management of hypotension induced by spinal and epidural anaesthesia , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[5]  J. Wildsmith,et al.  Prevention and treatment of hypotension during central neural block. , 1993, British journal of anaesthesia.

[6]  J. Eisenach,et al.  The vascular mechanism of ephedrine's beneficial effect on uterine perfusion during pregnancy. , 1991, Anesthesiology.

[7]  R. Maida-Claros,et al.  [Lactic acidosis in recovered asphyctic newborn infants]. , 1989, Boletín Médico del Hospital Infantil de México.

[8]  N. Hollis,et al.  Spinal anaesthesia for Caesarean section , 1987 .

[9]  S. Datta,et al.  Method of Ephedrine Administration and Nausea and Hypotension during Spinal Anesthesia for Cesarean Section , 1982 .

[10]  S. Caritis,et al.  Prophylactic Intravenous Ephedrine Infusion during Spinal Anesthesia for Cesarean Section , 1982, Anesthesia and analgesia.

[11]  S. Datta,et al.  Spinal anaesthesia for Caesarean section , 1982 .

[12]  S. Datta,et al.  Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. , 1982, Anesthesiology.

[13]  B. Young,et al.  Fetal lactic acidosis with epidural anesthesia. , 1982, American journal of obstetrics and gynecology.

[14]  D. H. Ralston,et al.  The Fetal and Neonatal Effects of Regional Anesthesia in Obstetrics , 1978, Anesthesiology.

[15]  D. Thompson,et al.  Prevention of spinal hypotension associated with Cesarean section. , 1976, Anesthesiology.

[16]  D. H. Ralston,et al.  Effects of Equipotent Ephedrine, Metaraminol, Mephentermine, and Methoxamine on Uterine Blood Flow in the Pregnant Ewe , 1974, Anesthesiology.

[17]  F. M. James,et al.  The Use of Inflatable Boots to Prevent Hypotension During Spinal Anesthesia for Cesarean Section , 1973, Anesthesia and analgesia.

[18]  F. M. James,et al.  An Evaluation of Vasopressor Therapy for Maternal Hypotension during Spinal Anesthesia , 1970, Anesthesiology.

[19]  L. S. James,et al.  Reliability of fetal blood sampling. Maternal-fetal relationships. , 1970, American journal of obstetrics and gynecology.

[20]  Richard Wohlgemuth,et al.  The electronic evaluation of fetal heart rate , 1960 .