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PragmaTic, prospEctive, randomized, controlled, double-blind, mulTi-centre, multinational study on the safety and efficacy of a 6% HydroxYethyl Starch (HES) solution versus an electrolyte solution in trauma patients: study protocol for the TETHYS study.

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Update on volume therapy in obstetrics.

Wendy H L Teoh1, Martin Westphal2, Tim G Kampmeier3

  • 1Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke University - NUS Graduate Medical School, Singapore.

Best Practice & Research. Clinical Anaesthesiology
|September 12, 2014
PubMed
Summary
This summary is machine-generated.

A mixed hydroxyethyl starch (HES) and Ringer

Keywords:
HEScaesarean deliverycolloidscoloadcrystalloidshypotensionobstetricspreloadspinal anaesthesiavolume

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Critical Care Medicine

Background:

  • Symptomatic hypotension is a common complication of spinal anesthesia during cesarean delivery.
  • Severe hypotension can adversely affect maternal and fetal outcomes.
  • Current strategies involve adjusting fluid preloads and vasopressor use.

Purpose of the Study:

  • To evaluate the efficacy of a mixed hydroxyethyl starch (HES) and Ringer's lactate (RL) preload compared to a pure RL preload in preventing hypotension during spinal anesthesia for cesarean delivery.
  • To assess the impact of the fluid preload strategy on maternal and neonatal outcomes.

Main Methods:

  • A multicenter, randomized, double-blinded trial (CAESAR trial) was conducted.
  • Participants received either a mixed 500 ml 6% HES 130/0.4 + 500 ml RL preload or a 1 L RL preload.
  • Hypotension was monitored, and maternal and neonatal outcomes were assessed.

Main Results:

  • The mixed HES + RL preload significantly reduced the incidence of hypotension compared to the 1 L RL preload.
  • No adverse effects on coagulation or neonatal outcomes were observed with the mixed preload.
  • This strategy demonstrated improved management of spinal-induced hypotension in cesarean delivery.

Conclusions:

  • A mixed HES and RL fluid preload is an effective strategy for reducing hypotension during spinal anesthesia for cesarean delivery.
  • This approach offers a safe and effective alternative to traditional RL preloading, improving maternal and fetal well-being.
  • The findings support a shift towards optimized fluid management in obstetric anesthesia.