Randomized double-blind comparison of intravenous ephedrine and hydroxyethyl starch 6% for spinal-induced hypotension in elective cesarean section

Purpose The aim of the study was to compare the efficacy of ephedrine versus hydroxyethyl starch (HES) 6% in prevention of hypotension during spinal anesthesia for cesarean delivery. Materials and Methods A total of 120 ASA physical status I and II parturients scheduled for cesarean delivery were assigned into four groups following induction of spinal anesthesia: group E – the ephedrine group (n = 30) received ephedrine 15 mg intravenous bolus immediately after spinal anesthesia was given and the patient returned to the supine position; group HES – the HES 6% group (n = 30) received 1000 ml of HES 6% just before spinal anesthesia was administered; group EHES – the ephedrine and HES 6% group (n = 30) received HES 6% 500 ml before administration of spinal anesthesia and ephedrine 15 mg intravenous bolus right after spinal anesthesia was given; and the last group was the control group, the LR group – lactated Ringer (n = 30), preloaded with lactated Ringer solution, 1000 ml infusion just before spinal anesthesia. The incidence of hypotension, reactive hypertension, nausea and vomiting, and Apgar scores at 1 and 5 min were noted. Results No significant demographic differences between groups were noted. The incidence of hypotension was significantly lowest in the group EHES and highest in the LR group (the control group). Moreover, the incidence of rescue ephedrine administration was lowest in the EHES group (3.3%) and highest in the LR group (55%). The incidence of nausea and vomiting was significantly lowest in the group EHES (3.3%) and highest in the group LR (53.3%). Conclusion HES 6% 500 ml before administration of spinal anesthesia and ephedrine 15 mg intravenous bolus right after spinal anesthesia is effective in preventing spinal-induced maternal hypotension during cesarean section.