Efficacy of Atropine to Blunt Unopposed Vagal Activity in Prevention of Hypotension in Parturients Undergoing Spinal Caesarean Section
Keywords:Atropine, Co-load, hypotension, Obstetric anaesthesia, Subarachnoid Anaesthesia
Objective: To determine efficacy of prophylactic atropine to blunt un-opposed vagal activity in prevention of hypotension
associated with caesarean spinal block in first 15 minutes.
Study Design & Setting: Randomized controlled interventional study (purposive sampling method) done at Islam Teaching
Hospital, Sialkot from 03-3-2021 to 11-8-2021
Methodology: Chairman Ethics Review Board, Islam Medical College, Sialkot vide letter No.2021-04/A, dated 03-3-2021,
consented for study. G-power statistics v188.8.131.52, employing chi-square goodness of fit test value of 11.07, total sample was
144 bunched into two prophylactic treatment groups by using computer generated numbers (group-A, Inj. atropine 0.5mg
and group-B, Inj. Placebo (control) planned for elective caesarean spinal delivery. Primary study variable being hemodynamic
stability (pulse, blood pressure) in first 15 minutes after placing block. Independent-Samples Kruskal-Wallis Test used to
compare systolic blood pressures between groups for association. Chi- square hypothesis test, was done with P-value <0.05
considered as statistically significant. SPSS analysis was done with v.21
Results: In Atropine group-A, there was rather a 11% increase in mean heart rate at 15 minutes mark (statistically significant)
than the mean baseline value while in group-B(placebo)similar values parameter showed a 4.7% decline in mean heart rate
value. In group-A, mean systolic blood pressure value declined only by 12.2% at 15 minutes mark from baseline value
whereas in group-B, a decline of 13.2% was noted.
Conclusion: Prophylactic bolus of atropine against un-opposed vagal activity provided stable hemodynamic values in
cesarean spinal delivery
Sugo Y, Kubota M, Niwa H, Hirota K. Moderate rate
of implementation of spinal anesthesia for cesarean
section: does it improve neonatal well-being? A case–-
control study. Sci Rep 2021; 11:245. https://doi.org/10.
Kim WH, Hur M, Park SK, Yoo S, Lim T, Yoon HK,
Kim JT, Bahk JH. Comparison between general, spinal,
epidural, and combined spinal-epidural anesthesia for
cesarean delivery: a network meta-analysis. Int J Obstet
Anesth. 2019; 37:5-15. https://doi.org/ 10.1016/j.ijoa.
Khan ZH, Eftekhar N, Barrak RS. General versus Spinal
Anesthesia During Caesarean Section: A Narrative
Review. Arch Anesth Crit Care 2019; 5(1): 18-21. https://
Sklebar I, Bujas T, Habek D. Spinal anaesthesia-induced
hypotension in obstetrics: prevention and therapy. Acta
Clin Croat. 2019;58(1):90–95.
Rattenberry W, Hertling A, Erskine R. Spinal anaesthesia
for ambulatory surgery. BJA Educ.2019;19(10):321-28.
Alegbeleye BJ. Sudden cardiac arrest under spinal
anesthesia in a mission hospital: a case report and review
of the literature. J Med Case Reports. 2018; 12:144.
Gelaw M, Haddis L, Abrar M, Aregawi A, Melese E.
Effects of prophylactic atropine in prevention of spinal
anesthesia induced hypotension and bradycardia in
geriatrics undergoing urological surgeries at a resource
limited setting in Central Ethiopia Int. J. Surg. Open
; prospective cohort study. 2020; 26:42- 48. https://doi.org/10.1016/j.ijso.2020.08.004
Akhtar FM, Pirzada A, Ashraf V. Prevention of hypotension in caesarean delivery under spinal anaesthesia; the
combination of modified supine wedged position, crystalloid cohydration and prophylactic atropine. PAFMJ
;58(4):429-36. https://pafmj.org /index.php/
Butterworth IV JF, Mackey DC, Wasnick JD. Morgan
& Mikhail Clinical Anesthesiology. 5th Edition. Appleton
and Lange 2013; 10: 189-98.
Sigdel S. Prophylactic use of IV atropine for prevention
of spinal anesthesia induced hypotension and bradycardia
in elderly: a randomized controlled trial.J Anesthesiol
Clin Sci. 2015; 4:5. https://doi.org/10.7243/2049-9752-
Arya S, Belwal S, Uniyal B, Tiwari B, Sharma P. Bezold
Jarisch Reflex- New Interest, Old Phenomenon, Am J
Intern Med. 2020;8(1):24-29. https://doi.org/ 10.11648/
Limongi JA, Lins RS. Cardiopulmonary Arrest in Spinal
Anesthesia. Rev Bras Anestesiol 2011;61(1):110-20.
Maqbool MS. Evaluation of Heart Rate Variability and
Baroreflex Sensitivity in Cesarean Spinal Delivery.
Med Forum 2018;29(3):78-82.
Warltier DC, Campagna JA, Carter C. Clinical Relevance
of the Bezold–Jarisch Reflex. Anesthesiology 2003;
Lim HH, Ho KM, Choi WY, Teoh GS, Chiu KY. The
use of intravenous atropine after a saline infusion in
the prevention of spinal anesthesia-induced hypotension
in elderly patients. Anesth Analg. 2000;91(5):1203-6.
Ferre F, Martin C, Bosch L, Kurrek M, Lairez O,
Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020; 13:39-
Lakshmi Vanaja N. Comparison of Atropine with Ephedrine in Prevention of Spinal Anesthesia Induced Hypotension in Elderly Age Group. Indian J Anesth Analg.
; 6:1973-77. DOI: http://dx.doi.org/10. 21088
Nze PU. Effect of pre-medication with atropine on the
blood pressure of parturient undergoing caesarian section
under spinal anaesthesia. Orient Journal of Medicine.
;15(1):1-4. DOI: 10.4314/ojm. v15i1.29037
19.Xu T, Zheng J, An XH, Xu ZF, Wang F. Norepinephrine intravenous prophylactic bolus versus rescue bolus
to prevent and treat maternal hypotension after combined
spinal and epidural anesthesia during cesarean delivery:
a sequential dose-finding study Ann Transl Med
Aweke, Z., Mola, S., Solomon, F.E., Ayalew, N., Hailu,
S., Neme, D et al. Prophylactic efficacy of intravenous
atropine with crystalloid co-loading for hemodynamic
stability in parturient undergoing cesarean delivery at
Dilla University Referral Hospital. A randomized controlled trial. Int. J. Surg. Open.2021;30(2): 100321.DOI:
Nze PUN. Effect of pre-medication with atropine on
the blood pressure of parturient undergoing caesarian
section under spinal anaesthesia. Orient J Med.
;15(1):1-4. DOI: 10.4314/ojm. v15i1.29037
Luo XJ, Zheng M, Tian G, Zhong HY, Zou XJ, Jian
DL. Comparison of the treatment effects of methoxamine
and combining methoxamine with atropine infusion to
maintain blood pressure during spinal anesthesia for
cesarean delivery: a double blind randomized trial. Eur
Rev Med Pharmacol Sci. 2016;20(3):561-567. PMID:
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