PRELOADING BEFORE SPINAL ANAESTHESIA IN CAESAREAN SECTION: A COMPARISON BETWEEN COLLOID AND CRYSTALLOID

Abstract

BACKGROUND:
Regional anaesthesia has become the preferred technique for caesarean
delivery compared to general anaesthesia.Regional anaesthesia is associated
with reduced maternal mortality, the need for fewer drugs, faster neonatal
maternal bonding, decreased blood loss and excellent postoperative pain
control. However maternal hypotension has remained the commonest serious
problem following spinal anaesthesia.Volume preloading has been
recommended for the prevention of spinal induced hypotension.
AIMS AND OBJECTIVES:
This study is a randomized comparative study to determine the effect of
crystalloid preloading using 30ml/kg of normal saline compared with 500ml of
6%hydroxyethylstarch.
PATIENTS AND METHODS:
A total of 88 parturient belonging to either ASA I or II were studied.
Forty four patients who received 30ml/kg body weight of normal saline as
preload were compared with forty four patients who received 500ml of 6%
hydroxyethylstarch (HES) as preload before spinal anaesthesia for caesarean
section.
RESULTS:
Twenty nine patients (65.90 %) developed hypotension in the crystalloid
group compared with nine patients (20.45%) in the colloid group. Seven
patients (15.91%) developed mild hypotension out of which six (13.64%) were
in the crystalloid group. Fourteen patients (31.82%) had moderate hypotension,
nine (20.45%) of which were in the crystalloid group. Fourteen (31.82%) and
three patients (6.82%) developed severe hypotension in the crystalloid and
colloid groups respectively. This was statistically significant. (p=
0.004).Volume of fluids used to maintain maternal haemodynamics were more
in the crystalloid group compared with the colloid group 4.4±9.9 and
1.2±0.7litres respectively. This difference was statistically significant
(p=0.033). The mean dose of ephedrine given to thehypotensive patients was
6.62mg and 6mg in the crystalloid and colloid groups respectively.
Although, Incidence of side effects of hypotension were more in the crystalloid
group when compared with the colloid group, neonatal outcome as assessed by
Apgar scores were comparable in the two groups studied.
CONCLUSION:
This study showed that 6% HES as a preload before spinal anaesthesia for
caesarean section is better in reducing the incidence of hypotension when
compared to 0.9% saline (normal saline).It also showed that 6% HES provides
better expansion of intravascular space and reduces the incidence of severity of
hypotension better than 0.9% saline.No adverse effects associated with 6% HES
was recorded in this study.

PRELOADING BEFORE SPINAL ANAESTHESIA IN CAESAREAN SECTION: A COMPARISON BETWEEN COLLOID AND CRYSTALLOID