Hydroxyethylstarch 10% is superior to Ringer's solution for preloading before spinal anesthesia for Cesarean section.
OBJECTIVE
To compare the preloading effect of 500 ml hydroxyethylstarch (HES) 10% with 1 L Lactated Ringer's solution (LR).


METHODS
In 40 healthy women undergoing elective Cesarean section HES, 500 ml (n = 20), or LR, IL (n = 20), was administered during 10 min before spinal anesthesia. The incidence of hypotension, (systolic blood pressure < 80% of baseline and < 100 mm Hg), and the amount of ephedrine used to treat it were compared. Also, the incidence of nausea and/or vomiting were recorded. Neonatal outcome was assessed using Apgar scores and umbilical venous and arterial blood gases.


RESULTS
The incidence of hypotension was higher in the LR than in HES group (80% vs 40%). Mean minimum systolic blood pressure was lower in the LR than in the HES group (86.1 +/- 12.7 mm Hg vs 99.6 +/- 9.7 mm Hg P < 0.05). Systolic blood pressure < 90 mmHg occurred in two of 20 patients (10%) who received HES vs 11 of 20 patients (55%) who received LR (P < 0.05). More doses of ephedrine were required to treat hypotension in the LRthan in the HES group (35.3 +/- 18.4 mg vs 10.6 +/- 8.6 mg; P < 0.05). The incidence of nausea and/or vomiting was lower in the HES than in the crystalloid group. Neonatal outcome was good and similar in both groups.


CONCLUSIONS
Preloading patients undergoing elective Cesarean section with 500 ml HES 10%, decreases the incidence and severity of spinal-induced hypotension more than preloading with 1 L of LR solution.
Siddik
S M
SM
Department of Anesthesiology, American University of Beirut, Lebanon.
Aouad
M T
MT
Kai
G E
GE
Sfeir
M M
MM
Baraka
A S
AS
D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D001802:Blood Substitutes / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000097:blood; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D003102:Colloids / Q000627:therapeutic use; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D007231:Infant, Newborn; D007552:Isotonic Solutions / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D020250:Postoperative Nausea and Vomiting / Q000209:etiology / Q000517:prevention & control; D011229:Preanesthetic Medication / Q000379:methods; D011247:Pregnancy; D000077325:Ringer's Lactate; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D001802:Blood Substitutes; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014662:Vasoconstrictor Agents; D002245:Carbon Dioxide; D004809:Ephedrine; D010100:Oxygen