Volume kinetics of Ringer’s solution and dextran 3% during induction of spinal anaesthesia for Caesarean section

Reports of Investigation



To study how the body handles fluid given intravenously during the onset of spinal anaesthesia in women scheduled for Caesarean section.


The effect of spinal anaesthesia on the volume kinetics of a constant-rate infusion of 25 ml · kg−1 of Ringer’s solution (n = 11) and 10 ml · kg−1 of dextran 3% 60 (n = 8) was studied before elective Caesarean section, Measurements of the blood haemoglobin concentration and urine excretion served as input variables in calculations of the size(s) of the body fluid spaces expanded by the infused fluid. The blood glucose level was also monitored.


When a one-volume kinetic model were fitted to the data, spinal anaesthesia reduced the size of the expanded body fluid space by 30% (Ringer’s) and 58% (dextran) (P < 0.02) When a two-volume model was statistically justified, anaesthesia reduced the rate of fluid equilibration between the two expanded body fluid spaces by 47% and 19%, respectively (P < 0.04) The baseline volume for the primary (central) fluid space was smaller than the expected plasma volume; 1.5 l for Ringer’s solution and 0.9 l for dextran. Only small changes in the blood glucose concentration were found.


The onset of spinal anaesthesia induces acute changes in the body’s handling of infused fluid that can be described by volume kinetic analysis.



Étudier le devenir des liquides administrés par voie intraveineuse durant l’induction de l’anesthésie rachidienne chez des parturientes subissant une césarienne.


Les effets de la rachianesthésie sur la cinétique volumétrique d’une infusion à débit constant de 25 ml · kg−1 de solution de Ringer (n= 11) ou de 10 ml · kg−1 de dextran 60 en solution à 3% (n = 8) ont été étudiés avant la césarienne élective. Les mesures du taux d’hémoglobine sanguin et du débit urinaire ont servi comme entrées variables dans le calcul de l’expansion volémique par le liquide infusé des différents compartiments corporels. La glycémie a aussi été mesurée.


Lorsque les données étaient rapportées à un modèle cinétique à un seul compartiment, l’anesthésie rachidienne entraînait une réduction du compartiment corporel déjà distendu de 30% pour le Ringer et de 58% pour le dextran (P 0.02). Lorsqu’un modèle à deux compartiments apparaissait justifié d’un point de vue statistique, l’anesthésie entraînait une réduction du taux d’équilibration entre les deux compartiments corporels déjà distendus de 47% et de 19% respectivement (P 0.04). Le volume de base pour le compartiment primaire (central) était plus petit que le volume plasmatique prévu: 1.5L pour le Ringer et 0.9L pour le dextran. La glycémie a peu varié.


Linduction de l’anesthésie rachidienne entraîne des modification aiguës de la gestion par le corps humain des liquides infusés, ces modifications pouvant être décrites par des analyses de cinétique volumétrique.


  1. 1.
    Jackson R, Reid JA, Thorburn J. Volume preloading is not essential to prevent spinal-induced hypotension at Caesarean section. Br J Anaesth 1995; 75: 262–5.PubMedGoogle Scholar
  2. 2.
    Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrease the incidence of hypotension after spinal anaesthesia for elective Caesarean section. Br J Anaesth 1992; 68: 394–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Murray AM, Morgan M, Whitwam JG. Crystalloid versus colloid for circulatory preload for epidural Caesarean section. Anaesthesia 1989; 44: 463–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Wennberg E, Frid I, Haljamäe H, Wennergren M, Kjellmer I. Comparison of Ringer’s acetate with 3% dextran 70 for volume loading before extradural Caesarean section. Br J Anaesth 1990; 65: 654–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Hallworth D, Jellicoe JA, Wilkes, RG. Hypotension during epidural anaesthesia for Caesarean section. Anaesthesia 1982; 37: 53–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Riley ET, Cohen SE, Rubenstein AJ, Flanagan B. Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer’s solution. Anesth Analg 1995; 81: 838–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Ståhle L, Nilsson A, Habn RG. Modelling the volume of expandable body fluid spaces during i.v. fluid therapy. Br J Anaesth 1997; 78: 138–43.PubMedGoogle Scholar
  8. 8.
    Hahn, RG, Drobin D, Ståhle L. Volume kinetics of Ringer’s solution in female volunteers. Br J Anaesth 1997; 78: 144–8.PubMedGoogle Scholar
  9. 9.
    Svensén C, Hahn RG. Volume kinetics of Ringer solution, dextran 70, and hypertonic saline in male volunteers. Anesthesiology 1997; 87: 204–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Hahn RG, Svensén C. Plasma dilution and the rate of infusion of Ringer’s solution. Br J Anaesth 1997; 79: 64–7.PubMedGoogle Scholar
  11. 11.
    Hahn RG, Drobin D. Urinary excretion as an input variable in volume kinetic analysis of Ringer’s solution. Br J Anaesth 1998; 80: 183–8.PubMedGoogle Scholar
  12. 12.
    Marx GF, Domurat MF, Costin M. Potential hazards of hypoglycaemia in the parturient. Can J Anaesth 1987; 34: 400–2.PubMedGoogle Scholar
  13. 13.
    Hahn RG. Haemoglobin dilution from epiduralinduced hypotension with and without fluid loading. Acta Anaesthesiol Scand 1992; 36: 241–4.PubMedGoogle Scholar
  14. 14.
    Drobin D, Hahn RG. Time-course of increased haemodilution in hypotension induced by extradural anaesthesia. Br J Anaesth 1996; 77: 223–6.PubMedGoogle Scholar
  15. 15.
    Hahn RG. Increased haemodilution in hypotension induced by epidural anaesthesia. Acta Anaesthesiol Scand 1993; 37: 357–60.PubMedGoogle Scholar
  16. 16.
    Hahn RG. A haemoglobin dilution method (HDM) for estimation of blood volume variations during transurethral prostatic surgery. Acta Anaesthesiol Scand 1987; 31: 572–8.PubMedGoogle Scholar
  17. 17.
    Ueland K. Maternal cardiovascular dynamics. VII. Intrapartum blood volume changes. Am J Obstet Gynecol 1976; 126: 671–7.PubMedGoogle Scholar
  18. 18.
    Guyton AC, Hall JE. Textbook of Medical Physiology, 9th ed. Philadelphia: W.B. Saunders Company, 1996: 297–8.Google Scholar
  19. 19.
    Bergman A, Andreen M, Blombäck M. Plasma substitution with 3% dextran-60 in orthopaedic surgery: influence on plasma colloid osmotic pressure, coagulation parameters, immunoglobulins and other plasma constituents. Acta Anaesthesiol Scand 1990; 34: 21–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Hahn RG. Origin of intravascular fluid recruited by vasodilatation during epidural anaesthesia. Eur Surg Res 1996; 28: 70–1.PubMedCrossRefGoogle Scholar
  21. 21.
    Arndt JO, Höck A, Stanton-Hicks M, Stühmeier K-D. Peridural anesthesia and the distribution of blood in supine humans. Anesthesiology 1985; 63: 616–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Qgilvie RI, Zborowska-Sluis D. Analysis of venous flow transients for estimation of vascular resistance, compliance, and blood flow distribution. Can J Physiol Pharmacol 1987; 65: 1884–90.Google Scholar
  23. 23.
    Innes IR, Nickerson M. Norepinephrine, epinephrine, and the sympathomimetic amines.In: Goodman LS, Gilman A (Eds.). The Pharmacoloical Basis of Therapeutics, 5th ed. New York: Macmillan Publishing Co., Inc., 1975: 500–1.Google Scholar
  24. 24.
    Thomas P, Buckley P, Fox M. Maternal and neonatal blood glucose after crystalloid loading for epidural Caesarean section. Anaesthesia 1984; 39: 1240–2.PubMedCrossRefGoogle Scholar
  25. 25.
    Philipson EH, Kalhan SC, Riha MM, Pimentel R. Effects of maternal glucose infusion on fetal acid-base status in human pregnancy. Am J Obstet Gynecol 1987; 157: 866–73.PubMedGoogle Scholar
  26. 26.
    Loong EPL, Lao TTH, Chin RKH. Effects of intrapartum intravenous infusion of 5% dextrose or Hartmann’s solution on maternal and cord blood glucose. Acta Obstet Gynaecol Scand 1987; 66: 241–3.CrossRefGoogle Scholar
  27. 27.
    Peng ATC, Shamsi, HH, Blancato LS, Shulman SM, Chervenak FA, Castro JL. Euglycemic hydration with dextrose 1% in lactated Ringer’s solution during epidural anesthesia for cesarean section. Reg Anesth 1987; 12: 184–7.Google Scholar
  28. 28.
    Kenepp NB, Kumar S, Shelley WC, Stanley CA, Gabbe SG, Gutsche BB. Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section. Lancet 1982; i: 1150–2.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1998

Authors and Affiliations

  1. 1.Department of Anesthesia, Karolinska Institute, Department of AnaesthesiaSöder HospitalStockholmSweden

Personalised recommendations