Prevention of hypotension in caesarean delivery under spinal anaesthesia; the combination of modified supine wedged position, crystalloid co-hydration and prophylactic atropine

ABSTRACT

To evaluate the efficacy of a modified supine wedged position with table tilt, crystalloid co hydration and prophylactic intravenous atropine in the prevention of hypotension in caesarean delivery under spinal anaesthesia. Phase 2 clinical trial. Place and Duration of Study PAF Hospital Masroor Karachi and PAF Hospital Rafiqi Shorkot Oct 2005 - April 2006. 40 parturients undergoing elective caesarean section under spinal anaesthesia were studied. Lactated Ringer's solution 10 ml/kg was administered over 10min.After Spinal in the sitting position with a 25-gauge Quincke needle using0.75% hyperbaric bupivacaine [12.75-15mg], the parturient was placed in the modified supine position with table tilt .Atropine 10microg/kg was given i/v. The baseline blood pressure and heart rate in each parturient before intervention [crystalloid co hydration, spinal, modified supine wedged position and i/v atropine] were taken as control and evaluated against the values after the intervention at different time intervals. Thirty nine out of forty patients completed the study. Mean upper sensory level was T4 at 6min post spinal. The mean spinal to delivery time was less than 12 min.5% of the parturients developed hypotension at 2 min post spinal. The mean heart rate was 96/min. The mean, systolic and diastolic blood pressures remained close to the base line values at 4, 6, 10, 12, 16 and 20 min post spinal. Modified supine wedged position with table tilt, crystalloid co-hydration and prophylactic i/v atropine is an effective combination technique which prevents spinal induced hypotension in caesarean delivery