Prophylactic Effects of Systemic Oral Ephedrine in Spinal Anesthesia-induced Hypotension during Transurethral Prostatectomy

Abstract

Objective: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. Material and Methods: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I ( n &#114 = &#114 30) received oral ephedrine 50 &#114 mg in addition to premedication whilst those in Group II ( n &#114 = &#114 30) received only premedication 30 &#114 min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 &#114 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 &#114 mmHg and <20% of baseline value. Hypotension was treated with 3 &#114 mg ephedrine and bradycardia was corrected with atropine 0.5 &#114 mg, given as an i.v. bolus. Results: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods ( p &#114 < &#114 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 &#114 &#45 &#114 0.97 &#114 mg in Group I and 8.86 &#114 &#45 &#114 1.24 &#114 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p &#114 = &#114 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. Conclusions: We conclude that a prophylactic oral dose of ephedrine 50 &#114 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.

• Ephedrine
• Hypotension
• Spinal Anesthesia
• Transurethral Resection Of The Prostate