Prevention of altered hemodynamics after spinal anesthesia: A comparison of volume preloading with tetrastarch, succinylated gelatin and ringer lactate solution for the patients undergoing lower segment caesarean section

Abstract

Background:Spinal anesthesia has replaced general anesthesia in obstetric practice. Hemodynamic instability is a common, but preventable complication of spinal anesthesia. Preloading the circulation with intravenous fluids is considered a safe and effective method of preventing hypotension following spinal anesthesia. We had conducted a study to compare the hemodynamic stability after volume preloading with either Ringer's lactate (RL) or tetrastarch hydroxyethyl starch (HES) or succinylated gelatin (SG) in the patients undergoing cesarean section under spinal anesthesia.Materials and Methods:It was a prospective, double-blinded and randomized controlled study. Ninety six ASA-I healthy, nonlaboring parturients were randomly divided in 3 groups HES, SG, RL (n = 32 each) and received 10 ml/kg HES 130/0.4; 10 ml/kg SG (4% modified fluid gelatin) and 20 ml/kg RL respectively prior to SA scheduled for cesarean section. Heart rate, blood pressure (BP), oxygen saturation was measured.Results:The fall in systolic blood pressure (SBP) (<100 mm Hg) noted among 5 (15.63%), 12 (37.5%) and 14 (43.75%) parturients in groups HES, SG, RL respectively. Vasopressor (phenylephrine) was used to treat hypotension when SBP <90 mm Hg. Both the results and APGAR scores were comparable in all the groups. Lower preloading volume and less intra-operative vasopressor requirement was noted in HES group for maintaining BP though it has no clinical significance.Conclusion:RL which is cheap, physiological and widely available crystalloid can preload effectively and maintain hemodynamic stability well in cesarean section and any remnant hypotension can easily be manageable with vasopressor.

Colloid preloading versus crystalloid preloading to prevent hypotension after spinal anesthesia for cesarean delivery

“…Only two studies reported the requirement of phenylephrine following spinal anesthesia induced hypotension. [ 39 , 44 ] A statistically significant reduction in phenylephrine requirement was observed with the use of colloid preloading compared with crystalloid preloading (standardized mean difference: -0.54, 95% CI: -0.82 to -0.25; 169 women; I 2 = 0%, P = .0002).…”

“…The incidence of intraoperative nausea and/or vomiting was reported in 20 trials. [ 15 , 17 , 20 , 23 , 24 , 26 , 27 , 29 , 30 , 32 – 35 , 37 , 39 – 42 , 44 , 47 ] Among these trials, a statistically significant reduction in nausea and/or vomiting was found when colloid preloading was administered compared with crystalloid preloading (risk ratio: 0.72, 95% CI: 0.55–0.95; 1601 women; P = .02; Fig. 5 ) with mild heterogeneity ( I 2 = 36%).…”

“…Clinical work dating from the 2000s indicated that phenylephrine effectively reduced hypotension and was associated with less neonatal acidosis than ephedrine. [ 48 ] Nineteen studies in our review used ephedrine as the vasopressor to treat hypotension, four studies [ 37 , 39 , 44 , 45 ] used phenylephrine, one study [ 23 ] used metaraminol and one [ 26 ] used dopamine. Logically, the requirement for vasopressors is consistent with the incidence of hypotension because the drug is used to treat hypotension.…”

Retraction

“…The ten articles listed below,[ 1 2 3 4 5 6 7 8 9 10 ] all with the same corresponding author and published in the Saudi Journal of Anaesthesia from 2014-2018, are being retracted because they have been found to have a number of unattributed sections of content with high rate of similarity from various other articles along with overwhelming evidence of data fabrication. The corresponding author and his institution were contacted and asked to provide the journal with the raw data for these studies but there has been no adequate response within a reasonable timeframe.…”