Résumé
This study was performed to determine if preoperative intravenous dextrose in two different regimens affects the incidence degree and case of treatment of hypotension during spinal anaesthesia for cesarean section, Also we aimed at evaluating the blood flow velocity waveforms [FVWS] of the uterine and umbilical arteries and the neonatal outcome in such cases.Sixty healthy parturients undergoing elective caesarean section under spinal anaesthesia were allocated into three groups [20 parturients in each] to receive intravenously either normal saline [group A], dextrose 5%, in normal saline [group B], dextrose 10% in normal saline [group C] at 125 mL/hr for two hours prior to delivery, Following a bolus of 15 mL/kg normal saline iv spinal anaesthesia was induced with hyperbaric bubivacaine 0, 5% fentanyl and morphine, Hypotension [systolic blood pressure < 100 mmHg or > 20% decrease] was treated with fluids and/or vasopressor. Data collected: Maternal demographics blood glucose concentrations [fasting at time of spinal and at delivery], blood pressure [baseline and at one minute intervals from spinal to delivery] and uterine and umbilical arteries Doppler FVW before preloading and 5 minutes after spinal anesthesia, Neonatal demographics neonatal Apgar scores umbilical blood gas analysis at birth glucose and lactate concentrations at birth. I and 2 hours after birth, There was no difference between the three groups in the rate of hypotension [p=0, 283]. All parturients who experienced hypotension received fluids and there was also no difference between the groups in vasopressor requirement. S/D in the uterine arteries increased significantly after spinal anaesthesia while it didn't change in umbilical arteries. There was no significant difference between the three groups regarding S/D in the umbilical and uterine arteries either before preload or 5 minutes after injection of the anesthestic. Umbilical arterial and venous pH was significantly lower and lactate was higher in group C than group A [P<0.05], after birth neonatal capillary blood glucose was stable in group A. but decreased significantly in group C [P<0.05] and lactate decreased in group C at 2h. We concluded that administration of dextrose 5% at a rate of 5.22 g/h and 10% at a rate of 10.22g/h preoperatively does not affect the hypotension rate uterine or umbilical Doppler FVW. or make it easier to treat hypotension and was potentially harmful to the foetus with the large dose of 10.22 g/h