Fluid Administration Before Caesarean Delivery: Does Type and Timing Matter?
BACKGROUND
The effectiveness of fluid preloading is in doubt, so co-loading has been attempted to reduce the incidence of spinal anaesthesia induced hypotension in caesarean patients.


OBJECTIVE
To compare crystalloid preloading, colloid preloading and colloid co-loading for prevention of maternal hypotension in caesarean delivery.


METHODS
Study conducted in tertiary level hospital on 90 ASA I/II term parturients posted for elective caesarean section. Patients were randomly allocated to three Groups.


METHODS
Group A (n=30) was given 10 ml/kg of 6% hydroxyethyl starch (HES) 20 minutes prior to spinal anaesthesia, Group B (n=30) was given 10 ml/kg of 6% HES by rapid infusion in 10 minutes immediately after spinal anaesthesia and Group C (n=30) was given 10 ml/kg of Ringer's Lactate 20 minutes prior to spinal anaesthesia. Intraoperatively, Heart rate, systolic, diastolic and mean arterial pressure were recorded every five minutes. Episodes of hypotension were recorded and treated with bolus of 5 mg of ephedrine and total amount of ephedrine was noted. Adverse effects, if any were recorded.


METHODS
ANNOVA for Quantitative Analysis and chi-Square test and Z-test for Qualitative Analysis.


RESULTS
Baseline parameters were similar in all the three Groups. Heart rate decreased from the baseline in all the three Groups, however, mean heart rate was highest in Group C. Heart rate was statistically similar in Groups A and B. MAP decreased in all three Groups from baseline, however, highest fall was recorded in Group C whereas, MAP was statistically similar in Groups A and B. Incidence of hypotension was 66.66% in Group C as compared to 36.66% in Groups A and 40% in Group B respectively. Group C patients received 5.33±4.54 mg of ephedrine as compared to 2.00±2.82 mg in Group A and 2.33±3.14 mg in Group B. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in Group C as compared to Groups A and B whereas, this difference was statistically not significant among Groups A and B.


CONCLUSIONS
Colloid preloading and co-loading are equally effective and both are superior to crystalloid preloading for prevention of maternal hypotension in caesarean section patients.
Senior Resident, Department of Anesthesia, AIIMS , Rishikesh, India .
Poonam
P
Arora
Professor, Department of Anesthesia, DMC & H , Ludhiana, India .
Rupinder M
RM
Singh
Associate Professor, Department of Anesthesia, DMC & H , Ludhiana, India .
Sandeep
S
Kundra
Professor, Department of Anesthesia, DMC & H , Ludhiana, India .
Parshotam Lal
PL
Gautam
Co-loading; Crystalloids; Preloading