COLLOID (3% DEXTRAN 70) WITH OR WITHOUT EPHEDRINE INFUSION FOR CARDIOVASCULAR STABILITY DURING EXTRADURAL CAESAREAN SECTION

• Published in: British journal of anaesthesia : BJA Vol. 69; no. 1; pp. 13 - 18
• Main Authors: WENNBERG, E., FRID, I., HALJAMÄE, H., NORÉN, H.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.1992; Oxford University Press
• Subjects: Abdominal surgery. Urology. Gynecology. Obstetrics; Adult; Anaesthesia; Anaesthetic techniques: extradural; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, Epidural - adverse effects; Anesthesia, Obstetrical - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cesarean Section; Colloids; Complications: hypotension; Dextrans - therapeutic use; Ephedrine - therapeutic use; Female; Fetal Blood - chemistry; Hemodynamics - drug effects; Humans; Hypotension - etiology; Hypotension - prevention & control; Medical sciences; nausea; Nausea - etiology; Nausea - prevention & control; obstetric: Caesarean section; Pregnancy; Sympathetic nervous system: ephedrine; volume pre-loading; Anaesthesia; Anaesthetic techniques: extradural; Complications: hypotension; obstetric: Caesarean section; Sympathetic nervous system: ephedrine; volume pre-loading; nausea; Dextran; Human; Regional anesthesia; Treatment; Vasopressor agent; Perfusion; Surgery; Extradural administration; Female; Hemodynamics; Colloid; Cesarean section
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/69.1.13

Using a non-invasive cardiac output monitor (Bo-Med NCCOM 3–R7J, we have compared cardiovascular responses, degree of haemodilution and incidence of nausea during extradural Caesarean section in healthy non-labouring mothers given either ephedrine 17.5mg and3% Dextran 70 7.5ml kg−1 before delivery (group A) or volume loading with Dextran 15 ml kg−1 without infusion of ephedrine (group B). Smallest systolic arterial pressures before delivery were 114 (SEM 4) mm Hg (group A) and 105 (5) (group B). There were no significant differences between the groups in mean arterial pressure, heart rate, systemic vascular resistance or central venous pressure, while cardiac output increased more with the ephedrine infusion (P < 0.05). Haemodilution was 8% in group A and 16% in group B at the time of delivery. Ephedrine infusion was associated with a smaller incidence of nausea (P < 0.01). Umbilical arterial pH values were not different between the two groups. We conclude that infusion of ephedrine, combined with low volume colloid administration, is a safe alternative to more extensive colloid volume expansion for control of hypotension and provides effective prophylaxis against nausea during extradural Caesarean section in healthy non-labouring mothers.