Ilango, G (2007) Evaluation of efficacy of Prophylactic Oral Ephedrine in prevention of Hypotension following Subarachnoid Block in Elective Lower Abdominal and Scrotal Surgeries. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Spinal anaesthesia or subarachnoid block as it is popularly called is one of the regional anaesthetic techniques achieved by blocking the spinalnerves in the subarachnoid space, by injecting local anaesthetic agent into the sub arachnoid space. Sub arachnoid block is commonly used in surgeries of the Lower abdomen and lower limbs. Though it is a blind procedure, it is easy to perform and gives good intensity of sensory, motor & sympathetic blockade of rapid onset. Depending upon the local anaesthetic injected the duration of blockade varies. Spinal anaesthesia2 has the advantage over General anaesthesia in preventing the sympathetic response from laryngoscopy and intubation. However it is not devoid of fatal complications of which hypotension and bradycadia are the hemodynamic complications resuting in significant morbidity and mortality. Many factors have been found to result in hypotension in midthoracic level subarachnoid block1 of which important ones are: (1) sympathetic blockade leading to decrease in systemic vascular resistance thereby causing hypotension. (2) Increased venous capacitance reducing the venous return causing decreased cardiac output leading to hypotension. (3) Bradycardia again by reducing the cardiac output results in hypotension. Hence it is of paramount importance to treat hypotension and its complications but prevention is better than allowing it to happen and treating it. Various methods have been tried to prevent hypotension. 1. parenteral administration of vasopressors, 2. preloading with crystalloids and colloids and, 3. using compression stocking or pneumatic devices in the lower limbs to improve venous return. Parenteral administration of ephedrine3 for prevention of hypotension has been tried in various clinical studies but not much studies have been done to know the efficacy of prophylactic oral administration of ephedrine. Therefore a prospective randomized clinical study is done to determine the efficacy of prophylactic oral ephedrine in reducing the incidence of hypotension following subarachnoid block in patients undergoing elective lower abdominal and scrotal surgeries. AIM OF THE STUDY: Aim of this study is to determine the efficacy of prophylactic oral ephedrine administered before subarachnoid block in minimising the incidence of spinal anaesthesia induced hypotension in patients undergoing elective lower abdominal and scrotal surgeries. MATERIALS & METHODS: After getting ethical committee approval and informed consent a randomised clinical study was conducted in 100 ASA class I men undergoing elective lower abdominal and scrotal surgeries under spinal anaesthesia to evaluate the efficacy of prophylactic oral ephedrine in prevention of spinal induced hypotension. This study was carried out in Govt. Stanley Medical College, Chennai during the period of Oct 2005 to Oct 2006. Inclusion Criteria: 1. ASA Class I patients, 2. Age between 25-55 Yrs, 3. Patients coming for lower abdominal and scrotal surgeries. Exclusion Criteria: 1. obesity, 2. Height less than 155cm, 3. Diabetes, 4. hypertension, 5. Ischaemic heart disease, 6. Chronic renal failure, 7. Anaemia, 8. Bleeding disorders, 9. Epilepsy. SUMMARY: In our study 100 ASA class I men scheduled for elective lower abdominal & scrotal surgeries under spinal anaesthesia were randomly divided into 2 groups. Group I patients (n = 50) received tab. Ephedrine 30 mg and Group II (control) patients did not receive tab Ephedrine We found out that Group I receiving Tab. Ephedrine 30mg had lower incidence of hypotension (2%) compared to Group II (Control) (38%) and did not report any side effects. CONCLUSION: From our study we conclude that oral ephedrine prophylaxis is a simple, easy, economical. effective and reliable method in reducing the incidence of hypotension following subarachnoid block in patients undergoing elective lower abdominal and scrotal surgeries and does not have any adverse effects.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prophylactic Oral Ephedrine ; prevention ; Hypotension ; Subarachnoid Block ; Elective Lower Abdominal ; Scrotal Surgeries. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 15:34 |
| Last Modified: | 28 Apr 2018 04:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7231 |
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