The Effects of Ephedrine and Prehydration on the Cardiovascular Response during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloid or colloid administration for the prevention of cardiovascular change during spinal anesthesia undergoing Transurethral Resection of Prostate (TURP). METHODS: Eighty ASA I-II patients scheduled for TURP under spinal anesthesia were randomly allocated to receive non of the vasopressors or fluids (control group), 40 mg of i.m. ephedrine (ephedrine group), 15 ml/kg of i.v. lactated Ringer'solution (crystalloid group), and 8 ml/kg of i.v. pentastarch(colloid group). 12 mg of 0.5% hyperbaric tetracaine was injected through a 24 gauge Quinke needle at the L4-5 interspace in all patients. All patients were placed in the supine position and blood pressure (BP) and heart rate were recorded at 1-min intervals for 10 min, 2-min intervals for the next 10 min and subsequently at 5-min intervals. The sensory level was determined by pin prick test using 27 gauge needle. RESULTS: In the ephedrine group, systolic blood pressure was significantly greater than the other groups between 1 and 40 min after spinal anesthesia. (p<0.05) The changes in diastolic BP, mean BP and heart rate in the all groups were similar. CONCLUSION: The result of intramuscular injection of ephedrine may be more effective than crystalloid or colloid adminstration for the prophylaxis of hypotension during spinal anesthesia undergoing TURP.

The Effects of Ephedrine and Prehydration on the Cardiovascular Response during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloid or colloid administration for the prevention of cardiovascular change during spinal anesthesia undergoing Transurethral Resection of Prostate (TURP). METHODS: Eighty ASA I-II patients scheduled for TURP under spinal anesthesia were randomly allocated to receive non of the vasopressors or fluids (control group), 40 mg of i.m. ephedrine (ephedrine group), 15 ml/kg of i.v. lactated Ringer'solution (crystalloid group), and 8 ml/kg of i.v. pentastarch(colloid group). 12 mg of 0.5% hyperbaric tetracaine was injected through a 24 gauge Quinke needle at the L4-5 interspace in all patients. All patients were placed in the supine position and blood pressure (BP) and heart rate were recorded at 1-min intervals for 10 min, 2-min intervals for the next 10 min and subsequently at 5-min intervals. The sensory level was determined by pin prick test using 27 gauge needle. RESULTS: In the ephedrine group, systolic blood pressure was significantly greater than the other groups between 1 and 40 min after spinal anesthesia. (p<0.05) The changes in diastolic BP, mean BP and heart rate in the all groups were similar. CONCLUSION: The result of intramuscular injection of ephedrine may be more effective than crystalloid or colloid adminstration for the prophylaxis of hypotension during spinal anesthesia undergoing TURP.

Effect of Ephedrine Infusion on the Prevention of Hypotension during Epidural Anesthesia / 대한마취과학회지

BACKGROUND: There has been no consensus on the best way to prevent hypotension during epidural anesthesia. We undertook the present study to evaluate the effect of ephedrine infusion along with fluid preloading in prevention of hypotension. METHODS: Eighty patients undergoing total abdominal hysterectomy were divided into 4 groups. The Group 1 and 2 were preloaded with 1000 ml lactated Ringer's solution(LR), Group 3 with 200 ml LR, and Group 4 with 500 ml of colloid(10% pentastarch) solution. In the group 1, normal saline was infused at 12 ml/min after bupivacaine injection into epidural space. In the Group 2, 3, and 4, ephedrine(mixed in normal saline) was infused after beginning of anesthesia at 1 mg/min. RESULTS: Systolic arterial pressure after epidural blockade was significantly lower in preloading of only LR(Group 1) than those with ephedrine infusion groups(Group 2, 3, and 4). In all groups the heart rate was not changed significantly during the course of the study. The central venous pressure increased after fluid preloading in all groups, but the magnitude of increase was relatively small in Group 3. Hypotension occurred in 45% of the patients who received only LR(Group 1) vs 10% of those who received pentastarch(Group 4)(p<0.05). The incidence of hypotension(20%) was same in Group 2 and 3. CONCLUSIONS: Infusion of ephedrine could be an alternative method to prevent hypotension during epidural anesthesia. Similar incidence of hypotension in Groups 2 and 3 challenges our perception of the value of crystalloid preload.

Clinical Anaylsis of Anesthetic Dosage and Use of Ephedrine in Epidural Anesthesia for Cesarean Section / 대한마취과학회지

BACKGROUND: Hypotension occurs frequently after epidural anesthesia. Intravenous fluid or vasopressors are among treatment methods to many suggested causes. This study was undertaken retrospectively to determine if the age, weight and height of parturients are related to the local anesthetic dosage in epidural anesthesia for the cesarean section, and if the dosage of local anesthetic influence the change of blood pressure and the requirement of fluid or epherine. METHODS: Sixty-nine parturients were studied by reviewing patients' anesthetic records. During lumbar epidural anesthesia to T4 sensory level, all patients were monitored with mean arterial blood pressure, and prevented from hypotension by administration of Ringer's lactated solution. But if hypotension has been sustained in spite of rapid fluid loading, intermittent ephedrine was injected. We studied the correlation of local anesthetic dosage, decrement of mean blood pressure and total required intravenous fluid volume, and difference of these variables between cases using ephedrine and not using. RESULTS: The volume of local anesthetic to achieve a T4 sensory level was 21.20 3.81ml, which did not correlate with age, weight and height, and did not influence the decrease of mean blood pressure and the volume of administered fluid. But the patients (n=30) who needed ephedrine were adminstered significantly larger dose of the local anesthetic and showed more decrease in the mean blood pressure than those (n=39) who did not. CONCLUSIONS: The dose requirement of local anesthetic during epidural anesthesia for the cesarean section is not determined by the age, weight and height of parturients. But when larger dose of local anesthetic is administered, the patients seem to be more hypotensive and need ephedrine as well as intravenous fluid administration.

Effects of Propofol in Combination with Ephedrine on the Hemodynamic Effects during Anesthesia Induction / 대한마취과학회지

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.