title: The effect of 0.5 L 6% hydroxyethyl starch 130/0.42 versus 1 L Ringer's lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis.
abstract: OBJECTIVE
  Fluid loading attenuates the hypotensive response to spinal anesthesia (SA). This study aimed to compare the preload efficacy of 0.5 L hydroxyethyl starch (HES) versus 1 L Ringer's lactate (R/L) in the prevention of hypotension after SA for elective cesarean delivery (CD). Assessment of maternal hemodynamic variables using FloTrac/Vigileo™ and neonatal outcome constituted secondary outcomes.
  
  
  METHODS
  Thirty-two ASA I/II parturients scheduled for elective CD were preloaded with either 1 L R/L (Group R/L, n = 16) or 0.5 L HES 6% 130/0.42 (Group T, n = 16) approximately 25 min before SA. Hypotension, defined as a 20% decrease of systolic arterial pressure (SAP) from baseline or SAP <100 mmHg, was treated with vasopressors according to a predetermined algorithm. The overall duration of hypotensive episodes and the total amount of vasopressors administered determined the severity of the hemodynamic instability.
  
  
  RESULTS
  The incidence of hypotension was 73.3% in Group R/L and 46.7% in Group T. HES compared to R/L preload was associated with a shorter overall duration of hypotensive episodes (p < 0.001), a significantly less usage of ephedrine and phenylephrine (p = 0.015 and p = 0.029, respectively) and a greater impact, although not statistically significant, on cardiac index (CI) and stroke volume index (SVI). Although no statistical difference was detected between groups over time, there was a significant drop in CI, SVI and SAP within groups (p < 0.001) up to 14 min after SA. No difference was recorded in neonatal outcome.
  
  
  CONCLUSIONS
  Preloading with 0.5 L HES 130/0.42 produced more stable hemodynamics compared to 1 L R/L solution in obstetric patients.
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece. matsota@yahoo.gr.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Matsota
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece.
authors.forename: Agathi
authors.initials: A
authors.lastname: Karakosta
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece.
authors.forename: Ageliki
authors.initials: A
authors.lastname: Pandazi
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Niokou
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Christodoulaki
authors.affiliation: 2nd Department of Anesthesiology, School of Medicine, University of Athens, "Attikon" Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section / Q000379:methods*; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007022:Hypotension / Q000453:epidemiology / Q000517:prevention & control*; D007552:Isotonic Solutions / Q000008:administration & dosage; D010656:Phenylephrine / Q000008:administration & dosage; D011247:Pregnancy; D011446:Prospective Studies; D000077325:Ringer's Lactate; D016037:Single-Blind Method; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004809:Ephedrine