A sequential compression mechanical pump to prevent hypotension during elective cesarean section under spinal anesthesia

Published:March 07, 2012DOI:



      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.


      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Obstetric Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Society of Anesthesiologists Task Force on Obstetric Anesthesia
        Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia.
        Anesthesiology. 2007; 106: 843-863
        • Clark R.B.
        • Thompson D.S.
        • Thompson C.H.
        Prevention of spinal hypotension associated with Cesarean section.
        Anesthesiology. 1976; 45: 670-674
        • Cyna A.M.
        • Andrew M.
        • Emmett R.S.
        • Middleton P.
        • Simmons S.W.
        Techniques for preventing hypotension during spinal anesthesia for cesarean section.
        Cochrane Database Syst Rev. 2006; 4: CD002251
        • Siddik-Sayyid S.M.
        • Nasr V.G.
        • Taha S.K.
        • Zbeide R.A.
        • Shehade J.M.
        • Al Alami A.A.
        A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery.
        Anesth Analg. 2009; 109: 1219-1224
        • Leykin Y.
        • Rubulotta F.
        Prophylactic continuous intravenous ephedrine infusion for elective Cesarean section under spinal anaesthesia.
        Eur J Anaesthesiol. 2003; 20: 257-258
        • Ngan Kee W.D.
        • Khaw K.S.
        • Ng F.F.
        Comparison of phenylephrine infusion regimens for maintaining maternal blood pressure during spinal anaesthesia for Caesarean section.
        Br J Anaesth. 2004; 92: 469-474
        • Adsumelli R.S.N.
        • Steinberg E.S.
        • Schabel J.E.
        • Saunders T.A.
        • Poppers P.J.
        Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia.
        Br J Anaesth. 2003; 91: 695-698
        • Rout C.C.
        • Rocke D.A.
        • Gouws E.
        Leg elevation and wrapping in the prevention of spinal hypotension following spinal anaesthesia in elective caesarean section.
        Anaesthesia. 1993; 48: 304-308
        • Prakash S.
        • Pramanik V.
        • Chellani H.
        • Salhan S.
        • Gogia A.R.
        Maternal and neonatal effects of bolus administration of ephedrine and phenylephrine during spinal anaesthesia for caesarean delivery: a randomised study.
        Int J Obstet Anesth. 2010; 19: 24-30
        • McCrae A.F.
        • Wildsmith J.A.W.
        Prevention and treatment of hypotension during central neural block.
        Br J Anaesth. 1993; 70: 672-680
        • Morgan P.
        The role of vasopressors in the management of hypotension induced by spinal and epidural anaesthesia.
        Can J Anaesth. 1994; 41: 404-413
        • Morgan P.J.
        • Halpern S.H.
        • Tarshis J.
        The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review.
        Anesth Analg. 2001; 92: 997-1005
        • Goudie T.A.
        • Winter A.W.
        • Ferguson D.L.M.
        Lower limb compression using inflatable splints to prevent hypotension during spinal anesthesia in cesarean section.
        Acta Anaesthesiol Scand. 1988; 32: 541-544
        • Christensen K.S.
        • Trautnera S.
        • Stockela M.
        • Nielsen J.F.
        Inflatable splints: do they cause tissue ischemia?.
        Injury. 1986; 17: 167-170
        • Sood P.K.
        • Cooper P.J.
        • Michel M.Z.
        • Wee M.Y.
        • Pickering R.M.
        Thromboembolic deterrent stockings fail to prevent hypotension associated with spinal anaesthesia for elective caesarean section.
        Int J Obstet Anesth. 1996; 5: 172-175
        • Sutherland P.D.
        • Wee M.Y.
        • Weston-Smith P.
        • Skinner T.
        • Thomas P.
        The use of thromboembolic deterrent stockings and a sequential compression device to prevent spinal hypotension during caesarean section.
        Int J Obstet Anesth. 2001; 10: 97-102
        • Ueyama H.
        • He Y.L.
        • Tanigami H.
        • Mashimo T.
        • Yoshiya I.
        Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective cesarean section.
        Anesthesiology. 1999; 91: 1571-1576