Comparative study between ephedrine infusion vs. CO/post loading of fluids for prevention of hypotension in emergency cesarean section under spinal anesthesia

Introduction
Maternal hypotension is the most common complication during cesarean section under spinal anesthesia. The aim of this study was to compare the effectiveness of CO/post loading of fluids versus immediate post spinal infusion of ephedrine in prevention of hypotension.
Methods
Ninety healthy pregnant patients ASA I with single term fetus arrived to the operating room with nonlife threatening cause for emergency cesarean section under spinal anesthesia. The patients were allocated randomly into 3 groups, : started the CO/post loading at the time of spinal injection and continued after it with 0.5 ml/kg/min Lactated Ringer’s solution until delivery of the fetus. : started the CO/post loading with 0.5 ml/kg/min Voluven at the same period. : started ephedrine infusion at 1 mg/min via the infusion pump immediately after spinal anesthesia until delivery of the fetus.
Results
The systolic blood pressure changes were statistically significant but they failed to reach clinical significant values in the three groups. The total dose of ephedrine was significantly higher in Ephedrine group than the other two groups. Intraoperative heart rate increased in the first 30 min in Ephedrine group without any clinical significance. All fetal data were within normal range and comparable between groups. Apger score of the fetuses was not less than 8 in the three groups. The incidence of nausea and vomiting was higher in group R and group V compared to group E.
Conclusion
Intravenous infusion of ephedrine 1 mg/min immediately after spinal anesthesia for emergency cesarean sections, even if there is no enough time for proper prehydration, can control effectively the hypotension without episodes of hypertension or significant tachycardia, and it had no effect on fetal well-being. It could be as effective as CO/post loading of 0.5 ml/kg/min lactated Ringer or Voluven in controlling systolic blood pressure with fewer incidences of post operative complications.