Details
Category: Volume 05 Issue 12 December 2017
Hits: 1283

Title: Prospective observational study of volume preloading prior to subarachnoid block in lower abdominal surgery with HETA starch (6%) and Ringer Lactate solution

Authors: Ujjwala B Khairmode, Padmanabha D V, Ramdas Morale

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i12.107

Abstract

We undertook a study to compare a colloidhetaethyl starch 6% with a crystalloid Ringer Lactate as preloading fluids for the prevention of sub arachnoid block induced hypotension.

Materials and Methodology: 100 patients were included in the study. Patients in Group R received Ringer’s lactate at 10 ml/Kg and Group H received 6% Heta starch at10 ml/Kg. Both these solutions were infused over a period of 20 minutes before performance of subarachnoid block. After preloading, all patients received Ringer’s Lactate solution as maintenance fluid. Under aseptic precautions lumbar puncture was performed with 25 gauge spinal needle (Quincke’s needle) through midline approach with patient in right lateral or left lateral decubitus position at third Lumbar intervertebral space. After free flow of CSF, 3.5 of 0.5% injection bupivacaine were injected. Immediately after the injection, the spinal needle is withdrawn and patient turned to supine position. Following Subarachnoid block, Systolic, Diastolic and Mean arterial blood pressure were recorded at following intervals -1,5,10,15,30,45,60,90 minutes and 3 hours after spinal anaesthesia. Sensory level of blockade was checked using pinprick method.

Results: Both groups were comparable with respect to preoperative pulse rate, blood pressure SBP and MAP without any statistically significant difference. There was a decrease in blood pressure in both the groups at 5 minutes and onwards after spinal anaesthesia. The difference was statistically significant at 10 min onwards. The decrease in blood pressure was maximum at 30 min in R group and 60 min in group H. After that blood pressure was stable although it was less compared to the pre-operative. Overall decrease in blood pressure was statistically significant as compared to pre-operative blood pressure. The incidence of hypotension was double in group R as compared to group H.The amount of mephenteramine required was 162 mg in group R and 60 mg in group H.The total IV fluid requirement was more in group R compared to group H.The incidence of decrease in pulse rate was almost similar in both groups but there was no bradycardia.Patients in group R experienced nausea (2 patients) and vomiting (1 patient).

Conclusion: Hexa ethyl starch 6% would be a better alternative to Ringer Lactate as a preloading fluid to prevent spinal induced hypotension.

Keywords: Preloading, Ringer lactate, Heta starch, subarachnoid block, hypotension.

References

  1. Greene N M. The physiology and spinal anaesthesia. 3rd edition, Baltimore : Williams and Wilkins, 1981;63;146, 265-73
  2. Gunusenet al.Effects of fluid preload compared with crystalloid co-load plus ephedrine infusion on hypotension and neonatal outcome during spinal anesthesia for caesarean delivery.Anesth intensive care.2010 Jul;38(4):647-53
  3. Hallworth D, Jellicoe J A , Wilkes R G. Hypotension during epiduralanaesthesia for caesrean section. Anaesthesia 1982; 37: 53-6
  4. Thorburn J, Moir D D. Epidural analgesia for elective caesarean section. Technique and its assessment. Anaesthesia 1980;35: 346
  5. Murray A M, Morgan M ,Whitmann J. Crystalloid versus colloid forcirculatory preload for epidural caesarean section. Anaesthesia 1989;44 :463-6
  6. Sathe U, Shah B N. Spinal preloading Colloids versus crystalloids. BullIntensive Crit Care 1996; 3:4-15
  7. Shapira S C ,Shir Y , Shapira Y A. Comparison of intravenous loadingfor epidural anaesthesia with Ringers Lactate or polygeline solutions. European J Pain 1991; 12 :100-3
  8. Bhagwanjee S, Rocke D A, Rout C C et al.:Prevention of hypotension following spinal anaesthesia for elective caesarean section by wrapping of the legs. British Journal of Anaesthesia 1991;65:819-22
  9. Gibbs C P ,Werba J V, Banner T E et al. Epidural anaesthesia :legwrapping prevents hypotension. Anaesthesiology 1983; 59 : A405
  10. Gondie T A , Winter W, Fergusson D J M. Lower limb compression using inflatable splints to prevent hypotension during spinal anaesthesia for caesarean section. Acta Anaesthesiologica Scandinavica 1988; 32 : 541-4
  11. James F M III, Greiss F C, Kenup R A. An evaluation of vasopressor therapy for maternal hypotension during spinal anaesthesia. Anaesthesiology 1970; 33 : 25-34.
  12. Kennedy R L. An instrument to relieve inferior vena cava occlusion.AmJ Obstet Gynecol. 1970;107; 331-3
  13. Cucchiara R F, Rest all C J. Mephenteramine and intravenous fluidsfor the prevention of hypotension associated with spinal anaesthesia. Anaesthesiology 1973; 39 :109-10
  14. Buggy, Brunner JA. Dopamine for the treatment of spinalhypotension during caesarean section. Anaesthesiology 1980;514-7
  15. Hemmingsen C, Poulson J A, Risbo A. Prophylactic ephedrine duringspinal anaesthesia : double blind study in patients in ASA groups 1-3.British Journal of Anaesthesia 1989; 63 : 340-2
  16. Wollman S B. Marx G F. Acute hydration for prevention of hypotension of spinal anaesthesia in parturients. Anaesthesiology 1968; 29:374-80
  17. Baraka A S, Taha S K, Ghabach M B, A Abla, Sibaii N, Nader A M. Intravascular administration of polymerized elatine versus isotonic saline for prevention of spinal induced hypotension. Anesthesia Analgesia 1994;78:301-5
  18. Sharma S K , Gajraj N M , Sidawi J E. Prevention of hypotension during spinal anaesthesia. A Comparison of intravascular administration of Hetastarch versus Lactated Ringer solutions. Anesthesia Analgesia 1997; 84 ; 111-4.
  19. Rao N S , Vijayalaxmi P R, Singh T P D. Crystalloid versus colloid preload for preventing hypotension in caesarean section under spinal anaesthesia IJIM. 1997; 8 : 66-9
  20. Col. Jaitwat, Col. Y V Suri. Comparative evaluation of Ringer Lactate and 3.5% Polygeline (Haemaccel) solution as preloading fluid for prevention of hypotension following spinal anaesthesia.
  21. French G W G , White J B, Howell S J et al. Comparison of Pentastarch and Hartmann’s solution for volume preloading in spinal anaesthesia for elective caesarean section. British Journal of Anaesthesia 1999; 83 : 475-7
  22. Singh N R, Singh K H , Singh N T. : Anaphylactoid reaction to modified fluid elatine. Indian. J. Anaesthesia 2001; 45 : 222-3
  23. Singh et al: Ringer lactate vshexa starch: Comparative study of preloading with ringer lactate v/s 6% hexa starch solutions to prevent hypotension following spinal anaesthesia in elective surgery. 1178-81.

Corresponding Author

Dr Padmanbha D V

Assistant Professor, Department of Anesthesia GMC, MIRAJ

Room no 6, I HR hostel, PVPGH Civil Hospital, Sangli, Maharashtra 416416

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.