Lower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload Compared to 9 ‰ saline solution in caesarean Delivery.

##plugins.themes.academic_pro.article.sidebar##

Published Dec 30, 2014
Download
pdf
Vol. 92 No. 6 (2014): Issue Jun 2014

##plugins.themes.academic_pro.article.main##

C. Romdhani
W. Trabelsi
A. Lebbi
I. Naas
H. Elaskri
H. Gharsallah
R. Rachdi
M. Ferjani

Abstract

Background: Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid.

aim : To compare the effect of two preloading regimens: 6% hydroxyethyl starch (HES) and 9‰ saline solution, to prevent hypotension after spinal anesthesia in cesarean delivery.

methods: 105 patients undergoing intrathecal anesthesia for elective cesarean delivery were randomized and allocated to receive a preload of 500 ml HES 130/0.4 (HES Group) or a preload of 1500 ml 9‰ saline solution (CR group). Blood pressure and heart rate were recorded at baseline and after spinal anesthesia (every minute for the first 10 min, every 3 min for the next 10 min, and then every 5 min for the last 20 min). The primary outcome was to compare the incidence of hypotension (defined as a 20% reduction in systolic arterial pressure from baseline) between the two preloading regimens. Vasopressor requirements (i.v. bolus of 6 mg ephedrine) were also compared.

results: The incidence of hypotension was 87% in the CR group and 69% in the HES group (p= 0.028). Ephedrine requirement, incidence of nausea, and/or vomiting and neonatal outcome did not significantly differ between the two groups.

Conclusion: The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution.

Keywords:

spinal anesthesia, hypotension, hydroxyethyl starch.

##plugins.themes.academic_pro.article.details##

References

  1. Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol 2010;23:304-9.
  2. Datta S, Alper MH, Ostheimer GW, Weiss JB. Method of ephedrine administration and nausea and hypotension during spinal anesthesia for cesarean section. Anesthesiology 1982;56:68-70.
  3. Roberts SW, Leveno KJ, Sidawi JE, Lucas MJ, Kelly MA. Fetal acidemia associated with regional anesthesia for elective cesarean Roberts SW, Leveno KJ, Sidawi JE, Lucas MJ, Kelly MA. Fetal acidemia associated with regional anesthesia for elective cesarean
  4. Allen TK, Muir HA, George RB, Habib AS. A survey of the management of spinal-induced hypotension for scheduled cesarean delivery. Int J Obstetr Anesth 2009;18:356-61.
  5. Rout CC, Rocke DA, Levin J, Gouws E, Reddy D. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anesthesia for elective cesarean section. Anesthesiology 1993;79:262-9.
  6. Banerjee A, Stocche RM, Angle P, Halpern SH. Preload or coload for spinal anesthesia for elective Cesarean delivery: a meta-analysis. Can J Anaesth 2010;57:24-31.
  7. Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. Anesthesiology 2007;106:843-63.
  8. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol 2004;4:26.
  9. Leo S, Sng BL, Lim Y, Sia AT. A randomized comparison of low doses of hyperbaric bupivacaine in combined spinal-epidural anesthesia for cesarean delivery. Anesth Analg 2009;109:1600-5.
  10. Graphpad. http://www.graphpad.com/quickcalcs/NNT1.cfm Accessed 10/06/2013.
  11. Madi-Jebara S, Ghosn A, Sleilaty G, et al. Prevention of hypotension after spinal anesthesia for cesarean section 6% hydroxyethyl starch 130/0.4 (Voluven®) versus lactated Ringer's solution. J Medic Liban 2008;56:203-7.
  12. Ko JS, Kim CS, Cho HS, Choi DH. A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery. Int J Obstetr Anesth 2007;16:8-12.
  13. Tamilselvan P, Fernando R, Bray J, Sodhi M, Columb M. The effects of crystalloid and colloid preload on cardiac output in the parturient undergoing planned cesarean delivery under spinal anesthesia: A randomized trial. Anesth Analg 2009;109:1916-21.
  14. Siddik SM, Aouad MT, Kai GE, Sfeir MM, Baraka AS. Hydroxyethylstarch 10% is superior to Ringer's solution for preloading before spinal anesthesia for Cesarean section. Can J Anaesth 2000;47:616-21.
  15. Corke BC, Datta S, Ostheimer GW, Weiss JB, Alper MH. Spinal anaesthesia for Caesarean section. The influence of hypotension on neonatal outcome. Anaesthesia 1982;37:658-62.
  16. Caritis SN, Abouleish E, Edelstone DI, Mueller-Heubach E. Fetal acid-base state following spinal or epidural anesthesia for cesarean section. Obstet Gynecol 1980;56:610-5.
  17. Mercier FJ, Bonnet MP, De la Dorie A, et al. [Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension]. Ann Fr Anesth Reanim 2007;26:688-93.
  18. Pouta A, Karinen J, Vuolteenaho O, Laatikainen T. Preeclampsia: the effect of intravenous fluid preload on atrial natriuretic peptide secretion during caesarean section under spinal anaesthesia. Acta Anaesthesiol Scand 1996;40:1203-9.
  19. Smiley RM. Burden of proof. Anesthesiology 2009;111:470-2.
  20. Teoh WHL, Sia ATH. Colloid preload versus coload for spinal anesthesia for cesarean delivery: The effects on maternal cardiac output. Anesth Analg 2009;108:1592-8.
  21. Siddik-Sayyid SM, Nasr VG, et al. A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery. Anesth Analg 2009;109:1219-24.
  22. Carvalho B, Mercier FJ, Riley ET, et al. Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery. Int J Obstetr Anesth 2009;18:150-5.
  23. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006:CD002251.