. Role of Dexamethasone in preventing post spinal hypotension in patient undergoing caesarean section – a randomized double blind placebo controlled study.

Spinal anesthesia is the most commonly used anesthesia technique in caesareansection but it has many side effects like hypotension, bradycardia, nausea,vomiting. Incidence of hypotension and bradycardia in non-obstetric populationis 33% and 13% but in obstetric population the incidence of post spinalhypotension is around 60%. (1) Using vasopressor has been highly recommendedfor routine prevention of post spinal hypotension during caesarean delivery.The commonly used vasopressor during caesarean delivery is phenylephrine butphenylephrine sometime causes maternal cardiac depression. (2) Nor adrenalineis another vasopressor characterized by alpha agonistic activity in addition toa weak beta agonistic activity so nor adrenaline is considered a vasopressorwith less cardiac depression effect (3) along with this dexamethasone shown toreduce post spinal hypotension by blunting Bezold Jarish reflux and increasingperipheral vascular resistance. (4)

Parturients scheduledfor caesarean section who will meet the inclusion criteria will be sensitizedregarding the study using the patient information sheet [both in English andodia] during the pre-anesthesia check-up.

Patients will be randomly allocated into two groups using a computer-generated randomizationchart to receiveeither intravenousdexamethasone 8mg (4)in the (Group A) and 2 ml normal saline in (group B) 15 minutes beforespinal anesthesia.(9, 10)

In the operating room, standard ASA monitors willbe attached (electrocardiography,pulse oximetry, non-invasive blood pressuremonitor).

Then spinalanesthesia technique will be performedwith the patient in the sitting position at L3-4 or L4-5level with 0.5% hyperbaric bupivacaine 10 to 12mg + 20 mcg fentanyl. The drugs will be administered intrathecally afterconï¬rmation of free backflow of cerebrospinal fluid througha 25-gauge Quinckespinal needle. SBP and HR will bemeasured for every 3 min till the deliveryof the baby.

References:

1.Sahoo T, SenDasgupta C, Goswami A, Hazra A. Reduction in spinal-                                  inducedhypotension with ondansetron in parturients undergoing caesarean section: adouble-blind randomised, placebo- controlled study. Int J Obstet Anesth.2012;21(1):24–8.

 2.Hasanin A, Mokhtar AM, Badawy AA, Fouad R. Post-spinal anesthesia hypotensionduring caesarean delivery, a review article. Egypt J Anaesth.2017;33(2):189–93.

 3.Hasanin AM, Amin SM, Agiza NA, Elsayed MK, Refaat S, Hussein HA, et al.Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension duringCaesarean Delivery: A Randomized Dose-finding Trial. Anesthesiology.2019;130(1):55–62.

 4.Ashoor TM, Hussien NS, Anis SG, Esmat IM. Dexamethasone blunts postspinalhypotension in geriatric patients undergoing orthopedic surgery: a doubleblind, placebo-controlled study. BMC Anesthesiol. 2021;21(1):11.