الفهرس 
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Abstract
E
phedrine infusion is more effective than fluid preload in prevention of hypotension due to spinal anesthesia for cesarean section without causing significant tachycardia or hypertension.
SUMMARY
S
pinal anesthesia is the preferred method for elective cesarean sections due to considerable risks regarding airway management associated with physiological changes of pregnancy. Hypotension is reported to occur in up to 80% of spinal anesthesia cases, it can lead to serious maternal complications as well as impairment of the uterine and placental blood flow.
Many approaches have been investigated to prevent spinal hypotension, e.g., fluid loading, vasopressors, or both. Intravenous fluid protocols have been investigated in many trials to prevent spinal hypotension, but the clinical results were not satisfactory.
Lately, investigators have turned their attention to vasopressor protocols to prevent spinal hypotension. Conventionally, ephedrine was regarded as the first-choice drug to maintain maternal blood pressure. Its sympathomimetic stimulant activity on α- and β-adrenergic receptors causes positive inotropic and chronotropic effects on the heart and maintains uterine blood flow.
We hypothesized that using ephedrine to maintain maternal blood pressure during spinal anesthesia for cesarean delivery provides better hemodynamic stability with subsequent better maternal and neonatal outcomes compared to volume preload.
In this study, we compared volume preload and ephedrine infusion to guard against the hypotensive effect of spinal anesthesia during cesarean delivery.
The results of the study showed that compared with volume preload, ephedrine maintained maternal blood pressure and uterine artery blood flow. Further, it was associated with lower numbers of hypotension and hypertension episodes and less frequency of bradycardia and tachycardia during cesarean delivery.
Furthermore, the numbers of boluses of vasopressors used during spinal anesthesia were lower in ephedrine compared with volume preload.