Title: Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience
Authors: Sreekala Devi K S, Sobha S, Jamuna Rani J
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.35
Abstract
Introduction: Today lumbar subarachnoid block is the anesthetic technique (Spinal anaesthesia) often selected for an elective caesarian section. It has definite advantages that it permits the mother to be awake, minimize the likelihood of maternal pulmonary aspiration, technical ease, rapid onset of action, profound sensory and motor block and high success rate. Maternal Hypotension has to be avoided since it can cause a comparable fall in uterine perfusion and placental perfusion leading to foetal hypoxia and acidosis. The foetal outcome in caesarian under spinal anaesthesia is most often rewarding since it avoids drug depression of the foetus from general anaesthetics or a high dose of local anaesthetic. Study was undertaken with a view to evaluate the maternal haemodynamic changes in elective caesarian sections under spinal anaesthesia with preloading of the circulation, and to compare the efficacy of the two different preloading solutions.
Materials and Methods: a randomised prospective study in which forty parturients included were randomly allocated to two groups of twenty each to receive either a crystalloid or colloid preloading in the operation theatre.the age limit of 20 to 30 yrs and had comparable height and weight.
Inclusion criteria: Only healthy ASA Grade I parturients at term with single normal pregnancies and scheduled for elective caesarian section were included in the study. The indication for caesarian section included repeat caesarian section, foeto pelvic disproportion or breech presentation.
Exclusion criteria: Those patients with multiple pregnancies, intrauterine growth retardation, pre-eclamptic toxaemia, anaemia, hypertension, any other systemic disorders or past history of renal disease, coagulation disorders or bleeding tendencies or allergic reactions were excluded from the study. Any parturient in labour, or with spinal deformity or not willing for regional anaesthesia were excluded from the study.
Observation and results: Maternal heart rate was recorded every 2 minutes and was found that there were no significant differences in the heart rates and maternal oxygen saturations (SpOz) in the 2 groups. Neonatal Apgar scores were noted at 1 minute and 5 minutes. It was observed that there was no significant difference in the 2 groups.
Conclusion: spinal hypotension in the parturients could not be avoided, colloid preloading of 500 ml could prevent the most severe form of hypotension. The 6% hydroxyethyl starch solution was found to be not only effective but also without adverse effects in this study.
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