Hydroxyethyl starch versus lactated Ringer’s solution preloading to prevent maternal hypotension during spinal anesthesia for cesarean section

Abstract

Objective: To study the efficacy of 6% hydroxyethyl starch (130/0.4) in combination with lactated Ringer’s solution compared with lactated Ringer’s solution alone as preloading fluid to prevent maternal hypotension during spinal anesthesia for cesarean section. Material and Methods: Parturients undergoing cesarean section at term were randomized to receive either 500 ml. of 6% hydroxyethyl starch (130/0.4) plus 500 ml. of lactated Ringer’s solution (n= 50), or 1000 ml. of lactated Ringer’s solution alone (n=50) prior to induction of spinal anesthesia. Hypotension, as well as Apgar score and intraoperative maternal complications were recorded. Hypotension was defined as a decrease in systolic blood pressure of less than 90 mmHg. or more than a 25% reduction in systolic blood pressure from baseline. A p value of less than 0.05 was considered statistical significance. Results: The prevalence of hypotension in the study and control groups were 58% and 70% respectively (p=0.2). There were no significant differences in the dose requirement for ephedrine, neonatal Apgar score, dizziness, shivering, or nausea and vomiting between the groups. Conclusion: The study showed no significant advantages of preloading with 500 ml. of 6% hydroxyethyl starch (130/0.4) plus 500 ml. of lactated Ringer’s solution compared with 1000 ml. of lactated Ringer’s solution to prevent maternal hypotension during spinal anesthesia for cesarean section.

Keywords

• cesarean section
• hypotension
• preload
• spinal anesthesia
• 6% hydroxyethyl starch (130/0.4)