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