IARS 2024-2025 International Outreach Travel Grant Interview: Prajjwol Luitel, MBBS

Optimal Ephedrine Dose to Prevent Maternal Hypotension in Spinal Anesthesia for Cesarean Delivery

As a postdoctoral research fellow in the Department of Perioperative Health Equity and Anesthesia at the T. U. Teaching Hospital in Maharajguynj in Nepal, Prajjwol Luitel, MBBS, noticed a gap in the knowledge on ephedrine infusion. Previous studies had primarily focused on comparing ephedrine with other vasopressors or analyzing its effectiveness when administered as a bolus combined with an infusion. Acknowledging the rising rate of cesarean deliveries in Nepal and the increasing risk of spinal hypotension, Dr. Luitel realized a solution was needed to improve patient outcomes. This led him to investigate the effectiveness of different low-dose ephedrine infusions in preventing spinal-induced hypotension during cesarean sections. His current study, Optimal Ephedrine Dose to Prevent Maternal Hypotension in Spinal Anesthesia for Cesarean Delivery, aims to provide evidence on the most effective low-dose ephedrine infusion strategy to prevent maternal hypotension while minimizing side effects. Ultimately, Dr. Luitel hopes this remedy will improve perioperative care for mothers undergoing cesarean deliveries. His hard work and this specific research were recently recognized with an IARS International Outreach Travel Grant. The results of his study will be shared as a digital poster during the 2025 Annual Meeting, presented by IARS and SOCCA. Below, he discusses the trajectory of this research and how this travel grant will impact his investigations and career in the future.

View digital poster under e-Poster sessions on the 2025 meeting app.

1. For this research, I am…

Investigator

2. What drew you to this area of research? Has it evolved since your initial research project?

Maternal hypotension is a common and serious complication of spinal anesthesia, occurring in over 80% of cases. Ephedrine, due to its sympathomimetic properties, is widely used to prevent this condition in obstetric anesthesia. Previous studies have primarily focused on comparing ephedrine with other vasopressors or analyzing its effectiveness when administered as a bolus combined with an infusion. However, limited research has been done on ephedrine infusion alone. This gap in knowledge led us to investigate the effectiveness of different low-dose ephedrine infusions in preventing spinal-induced hypotension during cesarean sections.

3. What are the goals you most want to accomplish in your work with this research project?

With the rising rate of cesarean sections in Nepal, the risk of spinal hypotension has also increased. Given that ephedrine is included in Nepal’s Essential Medication List, optimizing its use is crucial. This study aims to provide evidence on the most effective low-dose ephedrine infusion strategy to prevent maternal hypotension while minimizing side effects, ultimately improving perioperative care for mothers undergoing cesarean sections. The output can be beneficial in guiding the dosing for ephedrine, minimizing its adverse effects, and proper usage.

4. What is the potential impact of your research on the field of anesthesia and patient care?

Our findings suggest that a lower ephedrine infusion dose (1.25 mg/min) is as effective as a higher dose (1.5 mg/min) in preventing maternal hypotension, with fewer side effects. This evidence could guide clinical practice in resource-limited settings, optimizing ephedrine use while improving maternal safety. Additionally, the study has opened avenues for future research in refining anesthesia protocols for cesarean deliveries.

5. How do you feel about receiving the IARS International Outreach Travel Grant?

I am truly honored and humbled to receive this grant. Attending this conference would not have been possible without the outreach grant, and this recognition further motivates me to pursue impactful research at my institution.

6. How will this grant affect your research and professional trajectory?

This grant allows me to showcase my work to a global audience, receive valuable feedback, and refine my future research directions. At this pivotal stage in my career, where I am exploring options for further training, exposure to international research and diverse perspectives will help me make informed decisions about my next steps. This experience reaffirms my commitment to research and strengthens my confidence in the relevance of my work.

7. What are the benefits of presenting your research at the IARS Annual Meeting?

Presenting at the IARS Annual Meeting offers an incredible opportunity to share my findings on an international stage and initiate conversations for potential collaborations. It will also serve as a learning experience for my research team, as I plan to share the insights and feedback I gain from the conference upon my return.

8. Is there anyone else you wish to acknowledge as part of this research team?

I sincerely appreciate the contributions of all the residents, nurses, and patients involved in this study. I am especially grateful to my mentors for their guidance and support throughout the research process.

9. Outside of your research, what might someone be surprised to learn about you?

In my free time, I enjoy listening to music and playing the guitar.