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

We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy.

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 = 30) received oral ephedrine 50 mg in addition to premedication whilst those in Group II (n = 30) received only premedication 30 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 min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 mmHg and <20% of baseline value. Hypotension was treated with 3 mg ephedrine and bradycardia was corrected with atropine 0.5 mg, given as an i.v. bolus.

SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods (p < 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 +/- 0.97 mg in Group I and 8.86 +/- 1.24 mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p = 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.

We conclude that a prophylactic oral dose of ephedrine 50 mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.