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Hydroxyethylstarch compared with modified gelatin as volume preload before spinal anaesthesia for Caesarean section
M P Vercauteren1, V Hoffmann, H C Coppejans
1Department of Anaesthesiology, University Hospital Antwerp, Belgium.
British Journal of Anaesthesia
|May 1, 1996
Summary
Crystalloid-hydroxyethylstarch combinations significantly reduced hypotension during Caesarean sections compared to gelatin or hydroxyethylstarch alone. However, large fluid volumes decreased packed cell volume, posing risks for anemic patients.
Area of Science:
- Anesthesiology
- Obstetrics
- Pharmacology
Background:
- Spinal anesthesia for Caesarean sections can cause hypotension.
- Fluid management strategies, including crystalloids and colloids, are crucial for maintaining hemodynamic stability.
- Different fluid combinations may impact hypotension incidence and hematological parameters.
Purpose of the Study:
- To compare the efficacy of different fluid preloading strategies in preventing hypotension during elective Caesarean sections under spinal anesthesia.
- To evaluate the impact of crystalloid-hydroxyethylstarch, crystalloid-gelatin, and hydroxyethylstarch-alone combinations on hemodynamic parameters and packed cell volume.
Main Methods:
- Ninety patients undergoing elective Caesarean sections under spinal anesthesia were studied.
- Three fluid groups were compared: lactated Ringer's with modified gelatin, lactated Ringer's with 6% hydroxyethylstarch, and 6% hydroxyethylstarch alone.
- Fluid volumes up to 2000 ml were administered as preload, with lumbar puncture occurring after 500 ml infusion.
Main Results:
- The crystalloid-hydroxyethylstarch combination showed significantly lower incidence of hypotension, reduced need for vasopressors, and lower ephedrine doses compared to other groups.
- Both groups receiving 2000 ml preload experienced a packed cell volume (PCV) decrease exceeding 20%, a potential concern for anemic patients.
- Patients receiving colloid without crystalloid had a 14% PCV decrease, with hypotension risk comparable to the crystalloid-gelatin combination.
Conclusions:
- Crystalloid-hydroxyethylstarch fluid combinations are effective in mitigating hypotension during spinal anesthesia for Caesarean sections.
- Careful consideration of fluid volume is necessary to avoid significant hemodilution and potential complications in patients with pre-existing anemia.
- The choice of fluid preload impacts both hemodynamic stability and hematological parameters in obstetric anesthesia.