Prevention of altered hemodynamics after spinal anesthesia: a comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

ABSTRACT

Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate [RL] or tetrastarch hydroxyethyl starch [HES] or succinylated gelatin [SG] in the patients undergoing cesarean section under spinal anesthesia. It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL [n = 32 each] and received 10 ml/kg HES 130/0.4; 10 ml/kg SG [4% modified fluid gelatin] and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure [BP], oxygen saturation was measured. The fall in systolic blood pressure [SBP] [<100 mm Hg] noted among 5 [15.63%], 12 [37.5%] and 14 [43.75%] parturients in groups HES, SG, RL respectively. Vasopressor [phenylephrine] was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance. RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor