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Hydroxyethylstarch 10% is superior to Ringer's solution for preloading before spinal anesthesia for Cesarean section

From the Department of Anesthesiology, American University of Beirut, Beirut, Lebanon.

Address correspondence to: Anis Baraka MD FRCA, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. Fax: 961-1-744464; E-mail: abaraka{at}aub.edu.lb

Purpose: To compare the preloading effect of 500 ml hydroxyethylstarch (HES) 10% with 1 L Lactated Ringer's solution (LR).

Methods: In 40 healthy women undergoing elective Cesarean section HES, 500 ml (n = 20), or LR, 1L (n = 20), was administered during 10 min before spinal anesthesia. The incidence of hypotension, (systolic blood pressure < 80% of baseline and < 100 mm Hg), and the amount of ephedrine used to treat it were compared. Also, the incidence of nausea and/or vomiting were recorded. Neonatal outcome was assessed using Apgar scores and umbilical venous and arterial blood gases.

Results: The incidence of hypotension was higher in the LR than in HES group (80% vs 40%). Mean minimum systolic blood pressure was lower in the LR than in the HES group (86.1 ± 12.7 mm Hg vs 99.6 ± 9.7 mm Hg P < 0.05). Systolic blood pressure < 90 mmHg occurred in two of 20 patients (10%) who received HES vs 11 of 20 patients (55%) who received LR (P < 0.05). More doses of ephedrine were required to treat hypotension in the LR than in the HES group (35.3 ± 18.4 mg vs 10.6 ± 8.6 mg; P < 0.05). The incidence of nausea and/or vomiting was lower in the HES than in the crystalloid group. Neonatal outcome was good and similar in both groups.

Conclusion: Preloading patients undergoing elective Cesarean section with 500 ml HES 10%, decreases the incidence and severity of spinal-induced hypotension more than preloading with 1 L of LR solution.

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