We undertook a study to compare a colloidhetaethyl starch 6% with a crystalloid Ringer Lactate as preloading fluids for the prevention of sub arachnoid block induced hypotension.

Materials and Methodology: 100 patients were included in the study. Patients in Group R received Ringer’s lactate at 10 ml/Kg and Group H received 6% Heta starch at10 ml/Kg. Both these solutions were infused over a period of 20 minutes before performance of subarachnoid block. After preloading, all patients received Ringer’s Lactate solution as maintenance fluid. Under aseptic precautions lumbar puncture was performed with 25 gauge spinal needle (Quincke’s needle) through midline approach with patient in right lateral or left lateral decubitus position at third Lumbar intervertebral space. After free flow of CSF, 3.5 of 0.5% injection bupivacaine were injected. Immediately after the injection, the spinal needle is withdrawn and patient turned to supine position. Following Subarachnoid block, Systolic, Diastolic and Mean arterial blood pressure were recorded at following intervals -1,5,10,15,30,45,60,90 minutes and 3 hours after spinal anaesthesia. Sensory level of blockade was checked using pinprick method.

Results: Both groups were comparable with respect to preoperative pulse rate, blood pressure SBP and MAP without any statistically significant difference. There was a decrease in blood pressure in both the groups at 5 minutes and onwards after spinal anaesthesia. The difference was statistically significant at 10 min onwards. The decrease in blood pressure was maximum at 30 min in R group and 60 min in group H. After that blood pressure was stable although it was less compared to the pre-operative. Overall decrease in blood pressure was statistically significant as compared to pre-operative blood pressure. The incidence of hypotension was double in group R as compared to group H.The amount of mephenteramine required was 162 mg in group R and 60 mg in group H.The total IV fluid requirement was more in group R compared to group H.The incidence of decrease in pulse rate was almost similar in both groups but there was no bradycardia.Patients in group R experienced nausea (2 patients) and vomiting (1 patient).

Conclusion: Hexa ethyl starch 6% would be a better alternative to Ringer Lactate as a preloading fluid to prevent spinal induced hypotension.

Keywords: Preloading, Ringer lactate, Heta starch, subarachnoid block, hypotension.

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Dr Padmanbha D V

Assistant Professor, Department of Anesthesia GMC, MIRAJ

Room no 6, I HR hostel, PVPGH Civil Hospital, Sangli, Maharashtra 416416

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