Prevention of Hypotension Related to Spinal Anaesthesia for Cesarean Section

Abstract

Aim: The aim of this study was to compare different infusion rates of fluids and ephedrine therapy to prevent hypotension due to spinal anaesthesia for cesarean section. Materials and Methods: 80 healthy, ASA I-II, term parturients, presented for elective caesarean section, were randomly divided into four groups. A preload of lactated Ringer 20 mL kg-1 in Group L, 500 mL 6% hydroxyethylstarch in Group H, 6% hydroxyethylstarch 500 mL and lactated Ringer 10 mL kg-1 in Group LH, were infused in 20 minutes immediately before spinal anaesthesia. In Group LE, lactated Ringer 10 mL kg-1 was infused in 20 minutes immediately before spinal anesthesia and ephedrine 0.25 mg kg-1 was administered in the first 3 minutes after spinal injection. All patients received lactated Ringer 5 mL kg -1 hr-1 for volume maintenance. Spinal anaesthesia was performed with a 27 G Quineke needle with 0.5% hyperbaric bupivacaine and fentanyl 15 μg in 3.5 mL at the level of L<inf>2-3</inf> or L<inf>3-4</inf> intervertebral spaces. Blood pressure, heart rate and SpO<inf>2</inf> were recorded in one minute intervals. The times of spinal injection, skin incision, uterine incision and delivery, and Apgar scores at first and fifth minutes were noted. Umbilical arterial and venous blood gases were analyzed. Results: Incidence of hypotension was not different among the groups. Heart rates at the 7th and 8th minutes were higher in Group LE than Group LH. Neonatal outcomes were similar among the groups. Conclusion: Prophylactic fluid administration and administration of ephedrine when needed are the best methods to prevent hypotension related to spinal anaesthesia in caesarean section.