title: Comparison of hydroxyethyl starch 6% and crystalloids for preloading in elective caesarean section under spinal anesthesia.
abstract: BACKGROUND
  Although controversial, many studies have shown effectiveness of colloid loading as a substitute for crystalloids on reducing the incidence of hypotension in spinal anesthesia. This study was conducted to compare the effects of three intravenous fluid regimens on hemodynamic changes following spinal anesthesia in cesarean section. The regimens included 6% Hydroxyethylstarch 130/0.4 (HES) as a colloid and two crystalloids (lactated ringer's solution and sodium chloride 0.9%).
  
  
  METHODS
  In a double-blind clinical trial, 90 otherwise healthy parturients candidate of elective caesarean section were randomly allocated to receive lactated ringer's solution (1000 ml), sodium chloride 0.9% (1000 ml) or HES (7.5 mL/Kg) as preloading before spinal anesthesia. Hemodynamic parameters including blood pressure and heart rate, umbilical cord blood pH and the neonatal Apgar score were compared among the three groups.
  
  
  RESULTS
  There was no difference in the basic hemodynamic measurements among the three groups. The incidence of hypotension and required dose of ephedrine was lower in HES group (p=0.008). There was no significant difference in umbilical cord blood PH or Apgar scores among intervention groups.
  
  
  CONCLUSIONS
  Preloading with HES is more effective than crystalloids in prevention hypotension after spinal anesthesia without significant difference in Apgar score and umblical cord blood pH.
authors.affiliation: Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahzad
authors.initials: M
authors.lastname: Alimian
authors.affiliation: Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Masood
authors.initials: M
authors.lastname: Mohseni
authors.affiliation: Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Safaeian
authors.affiliation: Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Hamid Reza
authors.initials: SH
authors.lastname: Faiz
authors.affiliation: Department of Anesthesiology and pain, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Azad
authors.initials: MA
authors.lastname: Majedi
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D001794:Blood Pressure / Q000187:drug effects*; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000627:therapeutic use*; D007022:Hypotension / Q000517:prevention & control*; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000627:therapeutic use*; D011247:Pregnancy
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions
keywords: Caesarian section; Crystalloid; Hydroxyethylstarch; blood pressure; spinal anesthesia