The efficacy of prophylactic combination therapy using ephedrine iv alongwith fluid preload as compared to fluid preloading alone or IV ephedrine alone in prevention of maternal hypotension during spinal anesthesia for caesarean section

Objectives: to compare the efficacy of prophylactic combination therapy using iv ephedrine in bolus doses in conjunction with fluid preload as compared to fluid preload alone or iv ephedrine alone,for prevention of maternal hypotension after spinal anesthesia for caesarean section. methodology: this hospital based study was conducted at department of anesthesiology & intensive care,cmh peshawar from sep 2011 to may 2012. ninety patients of asa grade i receiving spinal anesthesia for elective caesarian section were randomly divided into three groups. group-i (crystalloid group) received only fluid preload with ringers solution 20ml/kg body weight; group-ii (ephedrine group) received iv ephedrine 0.25mg/kg bw only just after initiation of sab and group iii (combination group) received fluid preload with ringers solution 20 ml/kg body weight plus ephedrine 0.25mg/kg bw given iv just after initiation of spinal anesthesia. intra operative hemodynamic changes and fetal outcome were monitored,recorded and the data were analyzed statistically. results: although incidence of hypotension was not much significant in all the three groups but haemodynamic stability was much better and sustainable in group iii receiving combination therapy. conclusions: prophylactic combination therapy with fluid preload in conjunction with iv ephedrine 0.25mg/kg bw can effectively prevent spinal induced maternal hypotension during cesarean section.