Ephedrine Infusion with Rescue Ephedrine Boluses versus Rescue Boluses alone for Preventing Hypotension during Spinal Anesthesia for Cesarean Delivery.

Background: Maternal hypotension is an unwanted consequence of the physiologic onset of spinal blockade, and causes both maternal and fetal effects. Maternal symptoms include nausea, vomiting, and a sense of ‘‘impending doom’’ from inadequate cerebral perfusion. Inadequate treatment of hypotension can ultimately end with the loss of consciousness and cardiovascular collapse. Materials and methods: We included 80 full term parturient (ASA I or II) with uncomplicated pregnancies. The patients were prospectively randomized into two groups. 80 patients received 1000 mL NaCl 0,9 % solution before the initiation of spinal anesthesia.  Maternal systolic blood pressure was measured every 1 minutes (for first 10 minutes) and then every 3 minutes. One group received ephedrine infusion (1 mg/min) with rescue ephedrine boluses (10 mg), (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients) and the other received rescue boluses alone (10 mg) , (usually defined as a maternal blood pressure ˂ 30% above baseline), (40 patients). Results: Gr 1 (Ephedrine infusion with rescue ephedrine boluses). The incidence of hypotension was at 8 patients (8/40 [20%]),(when an absolute value of less than 90 mmHg). Gr 2 (rescue boluses ephedrine alone). The incidence of hypotension was at 32 patients (32/40 [80%]), (when an absolute value of less than 90 mmHg). Group 2 had a higher incidence of hypotension compared with group 1 (32/40 [80%]) vs (8/40 [20%]). Neonatal outcomes were not different between the 2 groups. Conclusion: Prophylactic variable rate ephedrine infusion and rescue ephedrine bolus dosing is more effective than relying on rescue ephedrine bolus dosing with respect to limiting clinician workload and maternal symptoms during spinal anesthesia for cesarean delivery.Maternal hypotension