Intravascular Administration of Polymerized Gelatin Versus Isotonic Saline for Prevention of Spinal-Induced Hypotension

Baraka, Anis; Taha, Samar K.; Ghabach, Maroun; Sibaii, A.; Nader, Antoun

doi:10.1213/00000539-199402000-00017

Cited by 40 publications

(28 citation statements)

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“…This difference in the incidence is probably due to the way in which hypotension is defined and to the changes related to the pregnancy in which blood pressure is measured. The present study supports the findings of Baraka et al 22 and Dehlgen G et al 20 which demonstrated a lower incidence of hypotension in parturients undergoing elective caesarean section who were preloaded with 15 ml/kg colloid than in those who received double volume of lactated ringer solution. This small volume of colloid can be administered quickly, within 10 min, allowing rapid and effective preloading prior to spinal anaesthesia for caesarean section, which is desirable in urgent situation.…”

Section: Resultssupporting

confidence: 92%

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The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Minj

Beck

Kumar

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: Spinal anesthesia for cesarean section is not a 100% successful technique. At times, despite straightforward insertion and drug administration, intrathecal anaesthesia for cesarean section fails to obtain any sensory or motor block.Methods: This study is aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to caesarean section under spinal anaesthesia following preload with either crystalloid or colloid. This study was carried out on 100 healthy pregnant women with single term foetus and not in labor admitted at the labor room of Gynecological department of RIMS. Blood pressure, Pulse rate, O2 Saturation and episodes of hypotension were recorded every 5 minutes from the spinal block.Results: The study showed that maximum number of caesarean sections here performed for the indication of foetal distress which is seen in 44%, 48%, 52%, and 48% in Group A, Group B, Group C and Group D respectively. This is followed by scar tenderness and obstructed labour. In Group A maximum number of patients developed hypotension during 11-20 minutes duration which is 13 (61.9%) followed by 5 (23.8%) patients during first 10 minutes.Conclusions: The study concludes that the combined use of volume preloading to compensate for vasodilatation and vasopressor to counteract arterial dilatation is a very effective method in reducing the incidence, severity and duration of spiral hypotension. The combination group with decreased volume of preload and reduced dose of vasoconstrictor provides better haemodynamic stability when compared to preloading of vasoconstrictors alone.

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Section: Resultssupporting

confidence: 92%

“…21 Baraka et al have shown that incidence of hypotension was higher in LR group than in HES group (80% vs. 40%). 22 In our study the incidence of hypotension in the Group A is in agreement with Dahlgren G et al 20 and Baraka et al 22 .…”

Section: Resultssupporting

confidence: 92%

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Minj

Beck

Kumar

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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“…9 Results showed that prophylactic administration is much more effective in attenuating hypotension following spinal anesthesia, when IM administration of either crystalloid or colloid produces equally satisfactory results. Epidural block develops slowly, which may result in moderate decrease in blood volume, which can be offered by either crystalloid or colloid.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Singh

Linus

2017

Int J Res Med Sci

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Background: Arterial hypotension following spinal anesthesia still remains the leading cause for maternal mortality and morbidity. Active management of hypotension and more so its prevention of its ads more safety value to spinal anesthesia, which is widely practiced worldwide. Preloading of patients with either crystalloid or colloid prevents the severity of hypotension. Objectives of the study was to compare the preloading efficacy of Ringers lactate solution (20 ml/kg) and 6% hydroxyl ethyl starch at 10 ml/kg in prevention of hypotension following spinal anesthesia in elective caesarean section.Methods: 100 ASA grade I and grade II subjects for elective caesarean section were studied in two groups. Group A (Ringer lactate group) 50 subjects and Group B (hydroxyl ethyl starch group) 50 subjects. Each group was preloaded over a period of 20 minutes before spinal anesthesia with either ringer lactate solution (Group A) at 20 ml/kg or 6% hydroxyl ethyl starch group at 10 ml/kg body weight. Main outcome measures were mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate.Results: Demographic characteristics of both groups were comparable. Incidence of hypotension was significantly more in ringer lactate group. There was no significant difference of heart rate in both the groups. No allergic reaction was noted to hydroxyl ethyl starch. Vasopressor requirement was also low in hydroxyl ethyl starch group compared to ringer lactate group.Conclusions: Preloading subjects with 6% hydroxyl ethyl starch is beneficial than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.

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“…• Preloading the patients with crystalloids or colloids like albumin, 2 Hetastarch, 15,16 Dextran, 17 and polymerized gelatin before spinal anesthesia was found to be effective in reducing the incidence of hypotension. This study was conducted on 60 patients who came for elective cesarean section under spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

2017

The Journal of Medical Sciences

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Introduction: Spinal anesthesia is widely used in the management of uncomplicated cesarean section. Maternal hypotension is the commonest serious problem which decreases uterine blood flow causing fetal hypoxia, acidosis, and neonatal depression. Fluid administration before start of the surgery (preloading) with crystalloid is found to be ineffective due to rapid redistribution of fluids in various tissue spaces. A "coload" given at the time of spinal anesthesia may be more effective. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used central venous pressure (CVP) measurement technique in parturients receiving rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in volume and therefore reduce vasopressor requirements. Materials and methods:We recruited healthy term women scheduled for elective cesarean delivery under spinal anesthesia for this randomized study. Baseline heart rate, baseline mean arterial blood pressure (MAP), and CVP were recorded. At the time of spinal injection, subjects were allocated to receive a rapid 1 L coload of either polymerized gelatin 3.5% (Haemaccel) or Hartmann (crystalloid) solution. The primary outcome CVP was compared between groups, as were secondary outcomes: phenylephrine dose and maternal hemodynamics data.Results: Maternal demographics, surgical times, and American Society of Anesthesiologists (ASA) were similar between groups. Baseline parameters were similar in all the three groups. Heart rate increased from the baseline in all the three groups; however, mean heart rate was highest in crystalloid group. Mean arterial blood pressure decreased in all the three groups from baseline; however, highest fall was recorded in crystalloid group. The incidence of hypotension was 66.66% in crystalloid group as compared with 36.66% in colloid group. Crystalloid group patients received 6.33 ± 4.54 mg of ephedrine as compared with 2.40 ± 2.82 mg in colloid group. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in crystalloid group as compared with colloid group. We found statistically significant differences in the mean preoperative CVP reading (p < 0.05) between the two groups, the mean CVP reading in crystalloid group being slightly lower. With preloading, similar CVP readings were obtained in both groups. The fall in CVP during subarachnoid blockade was also not significant. The CVP began to fall with the establishment of the block until the delivery of the baby after which it was found to rise. The predelivery CVP was significantly lower than preoperative CVP in both groups-the fall being significantly more in crystalloid group. Conclusion:In our study, the results showed statistically significant decrease in volume requirement, when colloid coload is used than crystalloid coload using C...

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Intravascular Administration of Polymerized Gelatin Versus Isotonic Saline for Prevention of Spinal-Induced Hypotension

Cited by 40 publications

References 0 publications

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

The incidence and management of hypotension in the pregnant parturients undergoing caesarean section following spinal anaesthesia with 0.5% bupivacaine

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

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