Abstract
The purpose of this study was to demonstrate the efficacy of oral ephedrine in preventing hypotension following subarachnoid block. Two hundred women, ASA physical status I or II, undergoing lower abdominal surgery were randomly divided into two groups (n = 100 each). All patients were given routine oral premedication consisting of diazepam 10 mg and ranitidine 150 mg at bed time and at 90 min before surgery. In addition, Group I patients received ephedrine 30 mg, orally, 30 min before subarachnoid block was administered. Group II received only routine premedication. After starting an iv line and preloading with 10 ml · kg−1 crystalloid, patients were given 0.5% heavy bupivacaine 3.2 to 3.6 ml, depending on body weight, intrathecally. Patients with decreases in blood pressure of 20% were given ephedrine iv, in increments, in addition to crystalloids. Despite a similar level of block (T3–T4) and iv fluids, the total dose of ephedrine supplement in Group I was 4.3 ± 4.8 mg compared with 11.6 ± 9.4 mg in Group II (P < 0.01). Also, 55 patients in Group I required intraoperative inotrope supplement compared with 83 in Group II (P < 0.01). We conclude that oral ephedrine premedication is a simple and effective way of reducing the incidence of hypotension in patients undergoing lower abdominal surgery under subarachnoid block.
Résumé
Cette étude vise à démontrer l’efficacité de l’éphédrine orale pour prévenir l’hypotension consécutive à la rachianesthésie. Deux cents femmes ASA I et II soumises à une chirurgie abdominale basse sont réparties au hasard en deux groupes (n = 100 par groupe). Elles reçoivent toutes la prémédication usuelle constituée de diazepam 10 mg et de ranitidine 150 mg au coucher et 90 min avant l’intervention. Les patientes du groupe I reçoivent en plus de l’éphédrine 30 mg per os 30 min avant la rachianesthésie. Le groupe II ne reçoit que la prémédication usuelle. Après l’installation d’un abord veineux, et une charge initiale de cristalloïde de 10 ml · kg−1, les patientes reçoivent en rachianesthésie de la bupivacaïne hyperbare 3,2 à 3,6 nil selon leur poids. Malgré un niveau d’analgésie (D3–D4) et une charge de liquide identiques, la dose additionnelle d’éphédrine pour le groupe I est de 4,3 ± 4,8 mg comparativement à 11,6 ± 9,4 mg pour le groupe II (P < 0,01). Cinquante-cinq patientes du groupe I ont eu besoin d’un inotrope additionnel peropératoire, comparativement à 83 du groupe II (P < 0,01). Nous concluons que l’éphédrine orale constitue une méthode simple et efficace permettant de réduire l’incidence d’hypotension en chirurgie abdominale basse sous rachianesthésie.
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Kafle, S.K., Malla, S.M. & Lekhak, B.D. Prophylactic oral ephedrine reduces the incidence of hypotension after subarachnoid block. Can J Anaesth 41, 1091–1093 (1994). https://doi.org/10.1007/BF03015660
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DOI: https://doi.org/10.1007/BF03015660