Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy.
OBJECTIVE
We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy.


METHODS
Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I (n = 30) received oral ephedrine 50 mg in addition to premedication whilst those in Group II (n = 30) received only premedication 30 min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 mmHg and <20% of baseline value. Hypotension was treated with 3 mg ephedrine and bradycardia was corrected with atropine 0.5 mg, given as an i.v. bolus.


RESULTS
SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods (p < 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 +/- 0.97 mg in Group I and 8.86 +/- 1.24 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p = 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods.


CONCLUSIONS
We conclude that a prophylactic oral dose of ephedrine 50 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.
Department of Anesthesiology and Reanimation, School of Medicine, Suleyman Demirel University, Balikci Sokak, Zehra Dilmen Apt. No:1/12, TR-32040 Isparta, Turkey. eroglufusun@hotmail.com
Fusun
F
Eroglu
Lutfi
L
Yavuz
Berit Gokce
BG
Ceylan
Guven
G
Sevin
Sedat
S
Soyupek
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D004809:Ephedrine / Q000008:administration & dosage* / Q000627:therapeutic use; D006339:Heart Rate; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011292:Premedication; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004809:Ephedrine