Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution.

Abstract

This study was designed to determine whether preoperative administration of 6% hetastarch decreases the incidence and severity of hypotension after spinal anesthesia for cesarean section. Forty nonlaboring ASA class I and II women having nonurgent cesarean sections were randomized to receive either 500 mL of 6% hetastarch plus 1 L lactated Ringer's solution (LR) (n = 20), or 2 L of LR (n = 20) prior to induction of spinal anesthesia. Hypotension occurred in 45% of patients who received hetastarch vs 85% of those who received only LR (P < 0.05), and minimum systolic blood pressure was lower in the LR group than in the hetastarch group (85 +/- 12 vs 93 +/- 12 mm Hg [mean +/- SD]; P < 0.05). In addition, the LR group had a higher maximum heart rate (115 +/- 17 vs 104 +/- 16 bpm), a shorter mean time to hypotension (7 +/- 4 vs 10 +/- 7 min), and required more 5-mg doses of ephedrine for treatment of hypotension (0 vs 2 [median]; P < 0.05) than the hetastarch group. Neonatal outcome, as determined by Apgar scores and cord blood gas analyses, was good and similar in both groups. We conclude that 6% hetastarch plus LR is more effective than LR alone and that its routine use before spinal anesthesia for cesarean section should be considered.

• Authors: E T Riley, S E Cohen, A J Rubenstein, B Flanagan
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 81 Issue 4 Pg. 838-42 (Oct 1995) ISSN: 0003-2999 [Print] United States
• PMID: 7574020 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Hydroxyethyl Starch Derivatives
• Isotonic Solutions
• Plasma Substitutes
• Ringer's Lactate

Topics

• Anesthesia, Obstetrical (adverse effects)
• Anesthesia, Spinal (adverse effects)
• Apgar Score
• Birth Weight
• Cesarean Section
• Double-Blind Method
• Female
• Fetal Blood (chemistry)
• Humans
• Hydroxyethyl Starch Derivatives (administration & dosage)
• Hypotension (etiology, prevention & control)
• Infant, Newborn
• Isotonic Solutions (administration & dosage)
• Plasma Substitutes (administration & dosage)
• Pregnancy
• Ringer's Lactate