Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy

Comparison of an ephedrine infusion with lidocaine %5 for prevention of hypotension during spinal anesthesia in cesarean section

Background

Spinal anesthesia is the method of choice for cesarean section and in most cases causes hypotension.

Objective

The aim of this study was to treat hypotension by ephedrine in order to prevent maternal and fetal complications, and also to determine the effective amount of ephedrine for reducing arterial hypertension in order to prevent its complications, including cardiac arrhythmias.

Method

This cross-sectional descriptive study was conducted on 131 patients. Mean arterial blood pressure (MAP) of the candidates for cesarean section in the supine position was measured and recorded as mean baseline blood pressure. 75 mg of lidocaine (5%) was used as spinal anesthesia, following which the average blood pressure was measured every 1 min. In the event of a decrease in the mean arterial blood pressure of at least 20% of the mean baseline blood pressure, ephedrine 0.1/mg/kg was injected intravenously and after 1 min of MAP was measured.

Result

The prevalence of hypotension was 89.30%. 25.60% of patients with hypotension had 30–34.99% reduction in MAP compared to baseline MAP. 12% patients had 40% drop in their MAP. 4 min following spinal anesthesia, the incidence of hypotension reduced by 20%. The average dose of ephedrine required to reduce the incidence of hypotension was 20.5 mg.

Conclusion

Reduction in MAP following spinal anesthesia using lidocaine is common. Ephedrine at the dose of 20 mg is effective to reduce the incidence of perioperative hypotension.

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Spinal anesthesia is the method of choice for cesarean section and in most cases causes hypotension.

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Arterial blood pressure drop after spinal anesthesia is very common in cesarean section.

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With lidocaine 5% and in most cases ephedrine is approximately 20 mg treated during the operation.

Comparison of effects of propofol and ketamine-propofol mixture (ketofol) on laryngeal mask airway insertion conditions and hemodynamics in elderly patients: a randomized, prospective, double-blind trial

PURPOSE

The objective of this study was to compare the effects of ketamine-propofol mixture (ketofol) and propofol on ProSeal laryngeal mask airway (PLMA) insertion conditions and hemodynamics in elderly patients.

METHODS

Eighty elderly patients, American Society of Anesthesiologists (ASA) physical status I and II, were randomly divided into two groups to receive either propofol 0.15 ml/kg (n = 40), or ketofol (using a 1:1 single-syringe mixture of 5 mg/ml ketamine and 5 mg/ml propofol) (n = 40) before induction of anesthesia. Sixty seconds after induction, the PLMA was inserted. Heart rate and arterial blood pressure (systolic [S] BP) were recorded prior to the induction of anesthesia, immediately following induction, immediately after PLMA insertion, and 5 and 10 min after PLMA insertion. PLMA insertion conditions were scored according to mouth opening, swallowing, coughing, head and body motion, laryngospasm, and ease of PLMA insertion by the same experienced anesthesiologist, who did not know which agents were used.

RESULTS

There were no differences in PLMA insertion conditions between the groups. The number of patients in need of ephedrine (P = 0.043) and the total dose of ephedrine (P = 0.022) were significantly lower, and apnea duration (P < 0.001) was significantly higher in the ketofol group compared with the propofol group. SBP was significantly higher in the ketofol group than in the propofol group immediately after PLMA insertion and 5 min after PLMA insertion.

CONCLUSIONS

The same PLMA insertion conditions were found with ketofol and propofol. The number of patients in need of ephedrine and the total ephedrine dose were lower and apnea duration was increased in the ketofol group.