title: Evaluation of antihypotensive techniques for cesarean section under spinal anesthesia: Rapid crystalloid hydration versus intravenous ephedrine.
abstract: BACKGROUND
  Spinal anesthesia is a preferred technique over general anesthesia for cesarean delivery. It avoids maternal airway related complications, aspiration and neonatal depression. However hypotension following spinal anesthesia can lead to decrease in uterine blood flow and neonatal hypoxia.
  
  
  OBJECTIVE
  We aimed to evaluate the efficacy of 15 mL.kg- 1of crystalloid preloading versus prophylactic intravenous bolus of 10 mg ephedrine as an antihypotensive measure for cesarean section.
  
  
  METHODS
  A prospective randomized double blind study was conducted in hundred ASA grade I/II parturient undergoing cesarean section, allocated to groupP(n=50) who received preloading with ringer lactate 15 mL.kg- 1 over 20 minutes before spinal anesthesia and group E (n=50) received intravenous bolus of 10mg ephedrine within one minute of spinal anesthesia with 10mg of hyperbaric bupivacaine 0.5% at L2-3/L3-4 level. They were monitored for incidences of hypotension, need of rescue doses of ephedrine, Apgar score and adverse events. Appropriate statistical tests were applied andP< 0.05 was considered as significant.
  
  
  RESULTS
  Incidence of hypotension within 20 minutes of spinal anesthesia was significantly less in group E (28%) as compared to groupP(58%) and need of rescue doses were more in group P. Adverse events like nausea vomiting and shivering were less in group E. Apgar score were better in group E than in groupPdelivered babies.
  
  
  CONCLUSIONS
  Prophylactic intravenous bolus of 10mg ephedrine with spinal injection is more effective in maintaining maternal hemodynamic stability and better neonatal outcome as compared to crystalloid preloading during cesarean delivery.
authors.affiliation: Departments of Anesthesiology and Pain Management, D Y Patil Medical College, Kolhapur, Maharashtra, India.
authors.forename: Kalpana Rajendra
authors.initials: KR
authors.lastname: Kulkarni
authors.affiliation: Departments of Anesthesiology and Pain Management, D Y Patil Medical College, Kolhapur, Maharashtra, India.
authors.forename: Amruta Girish
authors.initials: AG
authors.lastname: Naik
authors.affiliation: Departments of Anesthesiology and Pain Management, D Y Patil Medical College, Kolhapur, Maharashtra, India.
authors.forename: Sunetra Girish
authors.initials: SG
authors.lastname: Deshpande
keywords: Cesarean section; crystalloid preloading; ephedrine; spinal anesthesia