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Hydroxyethylstarch 10% is superior to Ringer’s solution for preloading before spinal anesthesia for Cesarean section

Abstract

Purpose: To compare the preloading effect of 500 ml hydroxyethylstarch (HES) 10% with I 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 Hgvs 99.6±9.7 mm HgP<0.05). Systolic blood pressure <90 mmHg occurred in two of 20 patients (10%) who received HESvs 11 of 20 patients (55%) who received LR (P<0.05). More doses of ephedrine were required to treat hypotension in the Lr than in the HES group (35.3±18.4 mgvs 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.

Conclusion: Preloading patients undergoing elective Cesarean section with 500 ml HES 10%, decreases the incidence and severity of spinal-induced hypotension more than preloading with I L of LR solution.

Résumé

Objectif: Comparer l’effet d’une précharge de 500 ml d’hydroxyéthylamidon (HEA) à 10 % avec celui de I L de solution de lactate de Ringer (LR).

Méthode: Pendant 10 min avant la rachianesthésie, on a administré chez 40 femmes qui devaient subir une césarienne 500 ml d’HEA (n=20) ou I L de LR (n=20). L’incidence d’hypotension (tension artérielle <80 % de la mesure de base et <100 mmHg) et la quantité d’éphédrine utilisée pour la traiter ont été comparées. De plus, l’incidence de nausées et/ou de vomissements a été enregistrée. L’indice d’Apgar et l’analyse des gaz du sang veineux et artériel ombilical ont permis d’évaluer les nouveau-nés.

Résultats: On a noté une plus grande incidence d’hypotension avec le LR qu’avec l’HEA (80 %vs 40 %). La moyenne des mesures de tension artérielle systolique minimale était plus basse dans le groupe LR que dans le groupe HEA (86,1±12,7 mmHgvs 99,6±9,7 mmHgP <0,05). La tension artérielle systolique <90 mmHg est survenue chez deux des 20 patientes (10 %) qui ont reçu de l’HEAvs 11 des 20 patientes (55 %) qui ont reçu du LR (P <0,05). Le traitement de l’hypotension a nécessité plus d’éphédrine dans le groupe LR que dans le groupe HEA (35,3±18,4 mgvs 10,6±8,6 mg;P <0,05). L’incidence de nausées et/ou de vomissements a été plus faible avec l’HEA qu’avec le cristalloïde. L’évaluation néonatale a été satisfaisante et similaire dans les deux groupes.

Conclusion: Une précharge de 500 ml d’HEA à 10 % chez des patientes qui vont subir une césarienne diminue plus l’incidence et la sévérité de l’hypotension induite par la rachianesthésie qu’une précharge avec I L de solution de LR.

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Correspondence to Sahar M. Siddik MD FRCA or Anis S. Baraka MD FRCA.

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Siddik, S.M., Aouad, M.T., Kai, G.E. et al. Hydroxyethylstarch 10% is superior to Ringer’s solution for preloading before spinal anesthesia for Cesarean section. Can J Anaesth 47, 616–621 (2000). https://doi.org/10.1007/BF03018992

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Keywords

  • Ephedrine
  • Neonatal Outcome
  • Lactate Ringer
  • Hetastarch
  • Lactate Ringer Solution