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The effect of 0.5 L 6 % hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis

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Abstract

Purpose

Fluid loading attenuates the hypotensive response to spinal anesthesia (SA). This study aimed to compare the preload efficacy of 0.5 L hydroxyethyl starch (HES) versus 1 L Ringer’s lactate (R/L) in the prevention of hypotension after SA for elective cesarean delivery (CD). Assessment of maternal hemodynamic variables using FloTrac/Vigileo™ and neonatal outcome constituted secondary outcomes.

Methods

Thirty-two ASA I/II parturients scheduled for elective CD were preloaded with either 1 L R/L (Group R/L, n = 16) or 0.5 L HES 6 % 130/0.42 (Group T, n = 16) approximately 25 min before SA. Hypotension, defined as a 20 % decrease of systolic arterial pressure (SAP) from baseline or SAP <100 mmHg, was treated with vasopressors according to a predetermined algorithm. The overall duration of hypotensive episodes and the total amount of vasopressors administered determined the severity of the hemodynamic instability.

Results

The incidence of hypotension was 73.3 % in Group R/L and 46.7 % in Group T. HES compared to R/L preload was associated with a shorter overall duration of hypotensive episodes (p < 0.001), a significantly less usage of ephedrine and phenylephrine (p = 0.015 and p = 0.029, respectively) and a greater impact, although not statistically significant, on cardiac index (CI) and stroke volume index (SVI). Although no statistical difference was detected between groups over time, there was a significant drop in CI, SVI and SAP within groups (p < 0.001) up to 14 min after SA. No difference was recorded in neonatal outcome.

Conclusions

Preloading with 0.5 L HES 130/0.42 produced more stable hemodynamics compared to 1 L R/L solution in obstetric patients.

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Acknowledgment

No financial support was provided.

Conflict of interest

None declared.

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Authors and Affiliations

  1. 2nd Department of Anesthesiology, School of Medicine, University of Athens, “Attikon” Hospital, Rimini 1 Str, Chaidari, 12462, Athens, Greece

    Paraskevi Matsota, Agathi Karakosta, Ageliki Pandazi, Dimitra Niokou, Kalliopi Christodoulaki & Georgia Kostopanagiotou

Authors
  1. Paraskevi Matsota
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  2. Agathi Karakosta
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  3. Ageliki Pandazi
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  4. Dimitra Niokou
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  5. Kalliopi Christodoulaki
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  6. Georgia Kostopanagiotou
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Corresponding author

Correspondence to Paraskevi Matsota.

Additional information

P. Matsota and A. Karakosta contributed equally in the study design and motivated the study.

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Matsota, P., Karakosta, A., Pandazi, A. et al. The effect of 0.5 L 6 % hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis . J Anesth 29, 352–359 (2015). https://doi.org/10.1007/s00540-014-1926-3

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  • DOI: https://doi.org/10.1007/s00540-014-1926-3

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