COMPARATIVE STUDY OF 6% HYDROXYETHYL STARCH (450/0.7) AND RINGER’S LACTATE AS PRELOADING FLUID FOR PREVENTION OF HYPOTENSION DURING SPINAL ANESTHESIA IN ELECTIVE CESAREAN DELIVERY
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2015, Vol 2, Issue 36
Abstract
We compared the efficacy of volume preloading with Ringer’s Lactate and Hydroxyethyl starch (HEAS) 6% 450/0.7 on the onset and incidence of spinal-induced hypotension in elective cesarean delivery. 60 healthy parturients scheduled for elective cesarean section under spinal anesthesia were selected for the study. Group A was preloaded with 1000ml of RL while as group B preloaded with 500ml of 6% HEAS (450/0.7) over a period of 10 minutes just prior to the administration of spinal anaesthesia. Immediately after the preloading period, subarachnoid block was instituted with 2.5ml of Bupivacaine 0.5% (heavy) at L3-L4 or L4-L5 interspace using 26 Gauge Quinke’s spinal needle in sitting position. The patient were then positioned supine with left lateral tilt. Adequate block was obtained and height of block was tested by pinprick method using blunt needle. Hypotension following spinal anaesthesia was treated with 6 mg bolus doses of Ephedrine and additional rapid infusion of Ringer’s lactate solution. All were administered supplemental oxygen 5L/min by venturi mask throughout the period of surgery. Intraoperatively, heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were monitored every 2 minutes for the first 20 minutes and every 5 minutes thereafter till the end of surgery. Spo2 and ECG were monitored continuously throughout the period of surgery. In addition, height of the block, amount of blood loss, amount of vasopressor required, and amount of i.v fluids used intraoperatively and any allergic reactions to i.v fluids were noted. All parturients received 10 IU of oxytocin i.v infusion after delivery of baby. These observations were analyzed to get information on the onset and incidence of hypotension, intraoperative requirements of Ephedrine, and i.v fluids, and incidence of adverse effects like nausea and/or vomiting. The incidence of hypotension in group A was 60% and that in group B 23.3%. The mean time period of onset of hypotension in group A was 6.3±2.09 (range 4-10 min) and that in group B was 12.9±2.27 (Range 10-16 min). The lowest systolic pressure noted in group A was 109. 8mmHg and in group was 113.9mmHg. None of the patients in group A and group B had bradycardia. The mean amount of Ephedrine required in group A and group B was 13 and 9.4 mg respectively. The average amount of i.v fluid used intra-operatively in group A was 1200±152.56 (Range 1000-1500 ml) and in group B was 1191.70±130.70 (Range 1000-1450 ml). The average intraoperative blood loss in group A was 837.50±65.90 (Range 750-1000 ml) and in group B was 819.20±64.56 (Range 750-950 ml). 4 patients in group A and 3 patients in group B developed vomiting. The neonatal Apgar scores were good and similar in both groups. CONCLUSION: It is concluded that:Among preloading agents, colloids are superior to crystalloids in reducing the onset and incidence of spinal-induced hypotension. Hydroxyethyl starch 6% is an ideal preloading agent. High molecular weight HEAS (e. g. 450/0.7) seems to be better option than Ringer’s anaesthesia in parturients scheduled for elective cesarean section. It is suggested to use 500 ml of high molecular weight 6% HEAS 450/0.7 as an effective prophylactic measure to reduce the incidence of spinal-induced hypotension in parturients planned for elective cesarean section. Also no allergic reaction with 6% HEAS 450/0.7 were observed in our study.
Authors and Affiliations
Javid Iqbal, Shafa Abeeda, Yasir Razak, Feroze Ahmad, Owasis Malik, Ab. Hamid Ab. Hamid, Aamir Nazir, Ihsanulla Ihsanulla
Keywords
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- EP ID EP232903
- DOI 10.18410/jebmh/2015/774
- Views 50
- Downloads 0
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