title: RAPID FLUID ADMINISTRATION AND THE INCIDENCE OF HYPOTENSION INDUCED BY SPINAL ANESTHESIA AND EPHEDRINE REQUIREMENT: THE EFFECT OF CRYSTALLOID VERSUS COLLOID COLOADING.
abstract: OBJECTIVE
  Spinal anesthesia for caesarean delivery is often associated with hypotension. This study was conducted to evaluate the effects of rapid crystalloid (Lactated Ringer's solution; LRS) or colloid (hydroxyethyl starch; HES) cohydration with a second intravenous access line on the incidence of hypotension and ephedrine requirement during spinal anesthesia for cesarean section.
  
  
  METHODS
  We studied 90 women with uncomplicated pregnancies undergoing elective cesarean section under spinal anesthesia. Intravenous access was established in all patients with two peripheral intravenous lines, the first being used for the baseline volume infusion. Immediately after induction of spinal anesthesia, LRS (Group L) or HES (Group C) infusions were started at the maximal possible rate via the second line in groups L and C respectively. In the third group (Group E), patients received lactated Ringer's solution at a 'keep vein open' rate to maintain the double-blind nature. The incidence of hypotension, ephedrine requirements, total amount of volume and side effects were recorded.
  
  
  RESULTS
  The incidence of hypotension was significantly greater in group E than in groups L and C, and greater in group L than in group C (p < 0.03 and p < 0.01 respectively ). The total dose of ephedrine used to treat hypotension was significantly less in groups L and C than in group E (p < 0.001 and p < 0.001 respectively). Groups L and C received similar infusion volumes and doses of ephedrine.
  
  
  CONCLUSIONS
  Giving either LR or HES coloading via a second IV line caused less hypotension and required less use of ephedrine compared to no coloading. There were no maternal or neonatal side effects.
authors: Hakki
authors: H
authors: Unlugenc
authors: Mediha
authors: M
authors: Turktan
authors: Ismail Cuneyt
authors: IC
authors: Evruke
authors: Murat
authors: M
authors: Gunduz
authors: Refik
authors: R
authors: Burgut
authors: Hacer
authors: H
authors: Yapicioglu-Yildizdas
authors: Geylan
authors: G
authors: Isik
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D002585:Cesarean Section / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004809:Ephedrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007022:Hypotension / Q000453:epidemiology / Q000209:etiology*; D015994:Incidence; D007552:Isotonic Solutions / Q000008:administration & dosage; D011247:Pregnancy; D000077325:Ringer's Lactate
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D004809:Ephedrine