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Prophylactic Intravenous Ephedrine to Minimize Fetal Bradycardia After Combined Spinal-epidural Labour Analgesia: A Randomized Controlled Study

Gambling, D.R.; Bender, M.; Faron, S.; Glaser, D.; Farrell, T.R.

doi: 10.1097/01.aoa.0000489466.69038.d4
Mechanisms, Equipment, Hazards
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(Can J Anaesth. 2015;62(11):1201–1208)

The combined spinal-epidural technique has many benefits, including rapid onset, superior first-stage analgesia, and the need for fewer supplemental doses when compared to a standard epidural. For these reasons, this technique is currently gaining in popularity. However, the combined spinal-epidural technique is also known to be associated with a risk of fetal bradycardia. The authors of this study attempted to determine whether the risk of this adverse outcome could be reduced by administering a prophylactic 10 mg dose of intravenous ephedrine. They also evaluated the rate of urgent cesarean delivery, the need for supplemental doses of ephedrine, maternal blood pressure, uterine hypertonus and tachysystole, as well as fetal heart rate patterns before and after the combined spinal-epidural.

Department of Anesthesiology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA

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