Abstract
Background
Spinal anesthesia is a standard technique for cesarean section but can cause hypotension
which may be related to venous pooling secondary to progesterone-induced decreases
in vascular tone. This study investigated the use of a sequential compression mechanical
pump with thigh-high sleeves with compression cycles timed to venous refilling. We
hypothesized that this would recruit pooled venous blood from the lower limbs, maintain
the central blood volume and thus decrease the incidence of hypotension.
Methods
One hundred parturients scheduled for elective cesarean section under spinal anesthesia
were recruited and randomly assigned to use of either a mechanical pump (Group M)
or control (Group C). A standardized protocol for co-hydration and anesthesia was
followed. Hypotension, defined as a decrease in systolic blood pressure by >20% from
baseline, was treated with 6-mg boluses of intravenous ephedrine. The incidence of
hypotension was defined as the primary outcome. Median ephedrine requirement was taken
as a measure of the severity of hypotension.
Results
Hypotension occurred in 12 of 47 (25.5%) patients in Group M compared to 27 of 45
(60%) in Group C (P = 0.001). The median [range] ephedrine dose was greater in Group C (12 [0–24] mg) compared to Group M (0 [0–12] mg) (P < 0.001). There was no difference between groups in the time to onset of hypotension.
Conclusion
The use of a sequential compression mechanical pump that detects venous refilling
and cycles accordingly, reduced the incidence and severity of hypotension after spinal
anesthesia for cesarean section.
Keywords
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Article info
Publication history
Published online: March 07, 2012
Accepted:
January 24,
2012
Identification
Copyright
© 2012 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
