Efficacy of Combination Therapy Using Crystalloid, Colloid and Ephedrine in Prevention of Post Spinal Hypotension at Cesarean Delivery

Abstract Background Spinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow. Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Objective To determine the most effective strategy to decrease the incidence and severity of post spinal hypotension by comparing three different combination therapies using crystalloid, colloid and ephedrine at cesarean delivery. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain Shams University, and written informed consent from all parturients this study was conducted in the operating theatres of Ain Shams Obstetric and Gynecology University Hospitals. Results In our study we found that a combination of an ephedrine infusion at 1.25 mg, minute with a crystalloid co-load was more effective in the prevention of hypotension. Conclusion Employing all mentioned combination treatments reduced the rate of hypotension occurrence following spinal anesthesia in parturients undergoing cesarean delivery. The most effective method was administration of crystalloid coloading plus ephedrine infusion.