Prevention of Hypotension After Spinal Anesthesia for Cesarean Section

Riley, Edward T.; Cohen, Sheila E.; Rubenstein, Adam J.; Flanagan, Brendan

doi:10.1213/00000539-199510000-00031

Cited by 61 publications

(76 citation statements)

References 16 publications

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“…19 During induction of anesthesia, the heart rate increased in both the groups, the rise being significantly higher throughout the procedure in the crystalloid group. This correlates well with studies by Mathru et al, 2 Rout et al, 18,20 and Riley et al, 21 who reported similar increase in the heart rate after induction of anesthesia. The highest heart rates were seen 2 to 4 minutes after spinal anesthesia and during extraction of the baby.…”

Section: Heart Rate Responsesupporting

confidence: 92%

“…Gradual fall in MAP was noted around 6 to 8 minutes thereafter. These findings corelate well with findings by Riley et al 21 and Karinen et al 22 The fall in arterial pressure after spinal anesthesia was a universal finding in all studies. 23 higher frequency of hypotension in crystalloid preload group was noted compared with colloid preload group.…”

Section: Blood Pressure Responsesupporting

confidence: 92%

“…With coloading, the arterial pressure (SAP) increased significantly in both groups (p < 0.001 for crystalloid, p < 0.001 for colloid). This is similar to reports by Mathru et al, 2 Riley et al, 21 and Karinen et al 22 After spinal anesthesia, the SAP fell in both groups. The degree of fall was significant, higher in crystalloid group (18.88 ± 7.58 mm Hg in crystalloid group vs 9.6 ± 6.02 mm Hg in colloid group, p < 0.001).…”

Section: Blood Pressure Responsesupporting

confidence: 91%

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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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Section: Heart Rate Responsesupporting

confidence: 92%

Section: Blood Pressure Responsesupporting

confidence: 92%

Section: Blood Pressure Responsesupporting

confidence: 91%

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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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“…The incidence of hypotension was 45% in hetastarch group and 85% in Ringer's lactate solution group. 5 This study reported a higher incidence of hypotension in both the groups compared to the findings of the present study.…”

Section: Discussionsupporting

confidence: 48%

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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“…19 On the other hand, the incidence of hypotension was 85% in those who received only Ringer's lactate solution 1000 ml. Karinen et al noted a low incidence of maternal hypotension with hetastarch 500 ml alone (38%) as compared with LR 1000 mL (62%) in patients undergoing caesarean section.…”

Section: Mandal M Et Al Int J Res Med Sci 2016 Jun;4(6):2428-2435mentioning

confidence: 98%

Comparison of crystalloid and colloid preload on maternal hemodynamics in elective caesarean section under spinal anaesthesia

et al. 2016

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INTRODUCTIONSpinal anaesthesia for caesarean section is the preferred option when balancing the risks and the benefits to the mother and foetus. With regional anaesthesia, the mother is able to share in the experience of the delivery, which may enhance mother-baby bonding. Hypotension after spinal anaesthesia for caesarean section remains a common and potentially serious complication. 1 Sympathetic block due to spinal anaesthesia along with aortocaval compression causes venous pooling leads to relative hypotension. This jeopardizes haemodynamic stability of mother and hampers blood flow to the placenta which may have detrimental effect on foetus.Techniques currently in use for preventing hypotension in elective caesarean section under spinal block include intravenous fluid pre-hydration, sympathomimetic drugs, ABSTRACT Background: Hypotension after spinal anaesthesia for caesarean section remains a common and potentially serious complication. Crystalloids are commonly used to counteract this adverse effect. Colloid solutions, such as albumin, hydroxylethyl starch (HES) and gelatin is effective alternatives. The main objective was to study to compare the effect of crystalloid and colloid preloading in elective caesarean section. Methods: It was a randomized controlled study conducted at North Bengal Medical College under Department of Anesthesiology in collaboration with Department of Gynaecology and Obstetrics from July 2011 to June 2012. Eighty patients were randomly allocated to two equal groups of 40 each in group 1 (Patients with Ringer's lactate) and group 2 (Patients with hydroxylethyl starch) before performing spinal anaesthesia. Results: In the present study, the incidence of hypotension was more in Ringer's lactate group than hydroxylethyl starch group. The fall of systolic blood pressure, mean blood pressure were higher in Ringer's lactate group (group 1) than 6% hydroxylethyl starch group (group 2). The changes in heart rate, SpO2 and respiratory rate were clinically insignificant in both groups. Also, the time intervals from induction to reach block height upto T5, incision-delivery were similar for group 1 and group 2. Also, there was no clinical difference in neonatal outcome as measured by Apgar scores at 1 minute and 5 minutes between group 1 and group 2. Conclusions: The preloading with 6% hydroxyethyl starch in elective caesarean section was able to prevent the maternal hypotension better than preloading with Ringer's lactate solution without any significant neonatal adverse effect.

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Prevention of Hypotension After Spinal Anesthesia for Cesarean Section

Cited by 61 publications

References 16 publications

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

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

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

Comparison of crystalloid and colloid preload on maternal hemodynamics in elective caesarean section under spinal anaesthesia

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