Comparison of Crystalloid Preloading versus Ephedrine Prophylaxis to Prevent Spinal Anesthesia Induced Hypotension during Cesarean Delivery: A Randomized Clinical Trial

Author(s): Yonatan Mehari Andemeskel, Daniel Habtom Brhane, Jemal Abulkereem MohammedAli, Teklit Mebrahtu Habtetsion

Hypotension in patients who take spinal anesthesia is a potentially serious issue. Expansion of the intravascular volume can be achieved by preloading with crystalloid fluids, which is a common practice in elective cases. Ephedrine, as a prophylaxis, has been recently practiced to prevent such occurrence. This study aimed to compare the efficacy between preloading with crystalloid fluid and administering ephedrine as a prophylaxis in the prevention of spinal anesthesia-induced hypotension during elective cesarean delivery. A total of 60 parturient mothers (30.98+4.69 years of age) appointed for elective cesarean delivery were randomly allocated to each group. The crystalloid group (n=30) received the usual management which is a crystalloid fluid 15 minutes prior to spinal anesthesia and the second group, ephedrine group (n=30) were given prophylactic ephedrine soon after receiving spinal anesthesia. Vital signs including blood pressure and pulse rate were recorded in time and patients were observed for the occurrence of complications related to spinal anesthesia. The primary endpoint was the change in the mentioned vital signs. The secondary endpoint included the occurrence of spinal anesthesia related complications. The overall mean SBP in the ephedrine group (M= 117.20, SD=10.19) was significantly greater (p=0.004) than the crystalloid group (M=106.43, SD=13.96). No significant difference was observed on the overall measure of pulse rate (p=0.238). The incidence of hypotension (46.7% vs 3.3%) as well as nausea and vomiting (46.7% vs 0%) were significantly higher in the crystalloid group (p<0.0001). In conclusion, administration of ephedrine as a prophylaxis is better than crystalloid preloading in the prevention of spinal-induced hypotension and associated complications.