title: Prevention of post-spinal hypotension using crystalloid, colloid and ephedrine with three different combinations: A double blind randomized study.
abstract: BACKGROUND
  The benefit of prophylactic combination therapy using crystalloid and colloid preload with ephedrine has not been cleared to prevent maternal hypotension after spinal anesthesia at cesarean delivery. This study evaluated the efficacy of three combinational methods to prevent hypotension following spinal anesthesia.
  
  
  METHODS
  In this prospective double blind trial, 150 candidates of elective cesarean delivery under spinal anesthesia were randomly allocated to three treatment groups; 1---Ringer's Lactate (RL) solution (15 ml/kg) plus Hemaxel (7 ml/kg) preload, 2---RL solution (15 ml/kg) preload plus ephedrine (15 mg, IV, bolus), 3---Hemaxel (7 ml/kg) preload plus ephedrine (15 mg, IV, bolus). Maternal hemodynamic changes during 60 min after spinal injection, nausea/vomiting, and neonatal condition were compared among the groups.
  
  
  RESULTS
  The cumulative incidence of hypotension was 44%, 40%, and 46% in groups 1 to 3, respectively. There were not significant differences in supplementary ephedrine requirement among groups which received or among groups which did not receive prophylactic ephedrine. Groups were not different in the incidence of hypertension and nausea or vomiting. There were no significant differences among groups in Apgar scores at 1 or 5 min and umbilical artery PH.
  
  
  CONCLUSIONS
  Combination of preventive methods decreased the occurrence of hypotension following spinal anesthesia to an acceptable level. Overall, the most effective method was a combination of crystalloid preload with ephedrine.
authors: Department of Anesthesiology, Anesthesiology and Critical Care Research center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Mitra
authors: M
authors: Jabalameli
authors: Hassan Ali
authors: HA
authors: Soltani
authors: Jalal
authors: J
authors: Hashemi
authors: Shekoofe
authors: S
authors: Behdad
authors: Bahram
authors: B
authors: Soleimani
keywords: Cesarean delivery; hypotension; spinal anesthesia