Comparison of Hetastarch and Hartman’s Solution for Volume Preloading For Elective Caesarian Section- A Tertiary Care Teaching Centre Experience

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.

References

1. Bromage PR. Physiology and pharmacology of epidural analgesia A- review- Anesthesiology 1967; 28: 592- 622.

2. Calvalho JCA, Mathias RS, Senra WG, Torres MKA, Vanocancelos A de Moraes JE, de Amarel RCG. Maternal, foetal and neonatal consequences of acute hydration during epidural enaesthesia for caesarian section. Regional anaesthesia 1993; 18(25): 19-21.

3. Claesy, Van Hemelrijck J Van Gervan M et al. Influence of hydroxyethyl starch on coagulation in patients during the perioperative period. Anesth Analg 1992 jul: 75(1) 24-30.

4. Catherine O Hunt, Spinal anaesthesia for obstetrics. International Anaesthesiology clinics 1987; 27(1): 26-30.

5. Condit D, Freeman K, Brodman R. Hyperamylasemia in cardiac surgical patients receiving hydroxy ethyl starch. Journal of critical care 1987;2:36-38.

6. Corke BC, Datta S, Ostheimer GW, Weiss JB Alper MH. Spinal anesthesia for caesarian section. The influence of hypotension on neonatal outcome. Anesthesia 1982; 37:658-662

7. Crawford J.S, Davies P. Status of neonates delivered by elective caesarian section. Br. J of Anaesth 1982; 54:10-15.

8. Claesy, Van Hemelrijck J Van Gervan M et al. Influence of hydroxyethyl starch on coagulation in patients during the perioperative period. Anesth Analg 1992 jul: 75(1) 24-30.

9. Catherine O Hunt, Spinal anaesthesia for obstetrics. International Anaesthesiology clinics 1987; 27(1): 26-30.

10. Condit D, Freeman K, Brodman R. Hyperamylasemia in cardiac surgical patients receiving hydroxy ethyl starch. Journal of critical care 1987;2:36-38.

11. Corke BC, Datta S, Ostheimer GW, Weiss JB Alper MH. Spinal anesthesia for caesarian section. The influence of hypotension on neonatal outcome. Anesthesia 1982; 37:658-662

12. Crawford J.S, Davies P. Status of neonates delivered by elective caesarian section. Br. J of Anaesth 1982; 54:10-15.

13. Crawford JS (1984). Principle and practice or obstetric anaesthesia 5th edn. Blackwell science publications.

14. Crawford JS. Experience with spinal analgesia in a British Obstetric Unit. Br. J Anaes 1979; 51:531-34.

15. De Marces H, De Calyya C, Hempelmann G, Sippel R. Effect of spinal anaesthesia on peripheral hemodynamics (German). Zeitschrift fur Kardiologies 1976 May; 65(5): 478-89.

16. Flung BK, Gislefoss AJ, Ho Es. Incidence of hypotension induced by spinal anaesthesia with xylocaine for caesarian section and post partum tube ligation. Ma Tusi Huseh Tsa chi 1992; 30(2): 119-123.

17. Fernando Arias, Birth Asphyxia. Practical guide to high risk pregnancy and delivery. 2nd edition. 20: 410-416.

18. Gajraj NM, Victory RA, Pace NA, Van Elstracte AC, Wallace DA, Comparison of an ephedrine infusion with crystalloid administration for prevention of hypotension during spinal anaesthesia. Aanesthesia Analgesia 1993; 76: 1023- 26.

19. George A Gregory. Resuscitation of the newborn. Anesthesia; 4th eidition 62: 2077- 2096.

20. Gonz alez de Z arate Api maniz J, cat on Valdes mn Alvarez L opez JC, Vega S Anchex JM, Ojida ortego J, Rheoloical and expander effect of hydroxyl ethyl starch in intradural anaesthesia. Rev Est Anesthesiol Reanim 1991 Mar- Apr; 38(2): 90-3.

21. Hankeln K, Senker R, Beez M. Comparative study of the intraopeative effectiveness of 5% human albumin and hydroxyethyl starch (HAES- Steril ) on haemodynamics and oxygen transport in 40 patients. Infusionstherapie 1990 Jun; 17(3): 135- 40.

22. Heilman L. Clinical results after hemodilutionwith hydroxy ethtyl starch in pregnancy (Germal ) Zeitschrift fur Geburtshilte and perinatalogie 1989 Sep - Oct 193 (5): 219- 25.

23. Heilman L Schinid - Schnobein H. Hemodynamic and hemorheologic findi-ngs in patients with pregnancy induced hypertension: Comparison of preeclampsia and chronic hypertension ( German). Klinische Wochensclirift 1990 68( 11) 559- 64.

24. Heilmann L, Hojnacki B. Value of haemodilution therapy in pregnancy (German). Acta Medica Austiraca. 185 suppl. 1:56-9,1991.

25. Heilmann L. Lorch E, Hojnacki B, Mintefering H, forster H. Accumulation of two different hydroxy ethyl starch preparation in the placenta after haemodilution in patients with fetal intrauterine growth retardation of pregnancy hypertension (German). Infusion therapie 18(5): 236- 43,1991 Oct.

26. Hubner, F Sander C, Doppler ultrasound findings in haemodilution with hydroxyl ethyl starch in intrauterine fetal retardation. Geburtshilfe and Frauenheil-kunde 1995 Feb 55(2): 87- 92.

27. Huovirian K, Lehtouitra P, Forss M et al. Changes in placental intervillous blood flow measures by 133 xenon method during lumbar epidural block for elective caesarian section. Acta Anaesthesiol Scand 1979;23:529-533.

28. J. Karinen, J. Rasanen, T Paavilainen, S Alahuhta, R Joupilla and P Joupilla. Uteroplacental and fetal haemodynamics and cardiac function of the fetus and newborn after crystalloid and colloid preloading for extradural caesarean section anaesthesia Br. J. Anaesthesia 1994; 73: 751- 757.

29. J. Karinen, J Rasanen, S Alahuhta, R Joupila and P Joupila. Effect of crystalloid and colloid preloading on maternal haemodynamic state during spinal anaesthesia for caesarian section. Br. J Anaes 1995; 75: 531-535.

30. JL. Vincnet. Fluids for resuscitation. British Journal of Anaesthesia 1991; 67" 185-193.

31. JA Thorburn J . Volume preloading is not essential to prevent spinal induced hypot-ension at caesarian section. British Journal of Anaesthesia. 1995; 75: 262- 265.

32. Joupilla R, Barinoff T et al. Placental blood flow during caesarian section performed under sub arachnoid block. Br. J Anaesth 1984; 56:1379- 82.

33. Joupilla P, , Joupilla P, Kuikka J, Hollman AL. Placental blood flow during caesarean section under lumbar extradural analgesia. British J Anaesthesia 1978; 50:275- 279.

34. Joupilla Kampen P. Haemodilution; regional block and caesarian section. Regional Anaesthesia 1990; 15( 15):9.

35. Kestin IG. Spinal anaesthesia in Obstetrics. Br. J Anaesthesia 1991; 66: 596- 607.

36. Kohler H, Zschiedrich H, Clasen R, Lifante A, Gamm H, Blood volume, colloid osmotic pressure and kidney function of healthy volunteers following infusion of medium molecular weight 10% Hydroxy ethyl starch 200.5 and 10% dixtran 40. Anaesthesist 31: 61( 1982).

37. Kuhnert BR, Philipson EH, Pinental R et al. LIdocaine deposition in mother, fetus and neonate after spinal anaesthesia. Anesth Analg 1986; 65:139-44.

38. Lakme LO, Liljedahl SO. Plasma volume change after infusion of various plasma expanders. Resuscitation 1976; 5: 93-102.

39. Marcus MA; vartommen JD; Van-Akan. H. Hydroxy ethyl starch versus lactated Ringer's solution in the chronic maternal fetal sheep preparation: apharmacodynamic and pharmakokinetic ■ study. Anesthesia Analgesia 1995; 80(5): 949- 54.

40. Marx GF Cosmi EV, Wolman SB. Biochemical status and clinical condition of mother and infant at caesarian section. Anesthesia Analgesia 1969; 48: 986- 993.

41. Marx G. F Husain F.J, and Shiau H.F Brachial and femoral blood pressures during the prenatal period. Am J obset gynecol 1980; 136: 11.

42. Mathru M, Rao TLK Kartha R.K Shanmugham M and Jacobs. Intravenous albumin administration for prevention of spinal hypotension during caesarian section. Anesh Anal 1980; 59: 655- 58.

43. Metacaff W; Papa do Poulos A; Aufaso R et al. A clinical physiologic study of hydroxy ethyl starch surg. Gynaecol. Obstet 1970; 131: 225- 267.

44. Miller JM, Bernard M, Brown HL etal. Umbilical cord blood gases for term healthy newborns. Am J Perinatol 1990; 7:157-159.

45. Moir DD. Local anaesthetic techniques in obstetrics. Br J Anaesth 1986; 58: 747- 749.

46. Morris MC Hyportension during spinal anaesthesia for caesarean section. Does it affect neonatal outcome. Regional Anaesthesia 1987; 12:191-193.

47. NRC Roberton Resusciation of the newborn. A manual of neonatal intensive care 2nd editiion 7:50- 51

48. Palot M, Visseaux. H, PireJ C Indications of albumin for vascular loading during pregnancy (french), annales francaises d anaesthesia et de Reanimation 1996,15(4): 491- 6.

49. Pouta AM, Karinen J, Vuolteenaho OJ, Laatikainen TJ. Effect of intravenous fluid preload on vasoactive peptide secretion during caesarian section under spinal anaesthesia. Anaesthesia. 1996. Feb, 51 ( 2): 128- 32

50. Ralston DH, Shnider SM, De Lorimier AA. Effects of equipotent doese of ephedrine, metaraminol, mephentermine and methoaxamine an uterine blood flow in pregnant eve. Anesthesiology 1994; 40:354- 370.

51. Ramanathan S, Gandhi S, Arismendy J et al. Oxygen transfer from mother to foetus during caesarean section under epidural anaesthesia. Anes Analg 1982; 61:576.

52. R.S. Alkinson, G.B Rushman, J alfred Lee. A synopsis of anaesthesia. Ninthe edition; 34: 727- 29.

53. Rebecca R, Qurnell BA and Virgina L Brook PHR Haemodynamic change, Baroreflex control in pregnancy. Americal J of Obstetrics and Gynaecology. 1997.

54. Robert K Stocking MD and Stepher F Dierdorf MD. Physiologic changes an diseases unique to the parturients. Anaesthesia and coexisting disease. 3rd ediction. 31:539-578.

55. Robson S, Hunter S, Boys R. Dunlop W. Bryson M. Changes in cardiac output duringepidural anaesthesia for caesarian section. Anesthesia 1989; 44(6): 475- 9.

56. Robson SC Samson G Boys RJ, Rodek C Morgen B. Incremental spinal anaesthesia for elective caesarian section; maternal and fetal haemodynamic effects. Br J of Anaesthesia 1993; 70 (6): 634- 638.

57. Robson SC, Boy RJ. Rodek C, Morgen B. Maternal and fetal haemodynamic effect of spinal and extradural anaesthesia for elective caesarean section. Br. J Anaes. 1992; 68(1): 54- 59.

58. Rout CC, Akoojee SS, Rocke DA, Gouws E. Rapid administration of crystalloid preload does not decrase the incidenc e of hypotension after spinal anaesthesia for elective caesarian section. Br J. Anaesth 1992; 68: 394- 397.

59. Rout CC, Rocke DA, Levin J, Gouws E. A reevaluation of the role of crystalloid preload in the prevention of hypotension associated with spinal anaesthesia for elective caesarian section. Anesthesiology 1993; 79: 262- 269.

60. Satproedpraj A, Samboonviboon W, Werawatganon T, Urusopone R The Effect of preload fluid for prevention of spinal hypotension in caesarian section. Indian J Int Med. 1995; 5: 37-41.

61. Scherer R, Gilbler R, Kampe S, Kox WJ. Effects of hypetonic saline hydroxy ethyl starch solution on collagen induced plateet aggregation and ATP secretion. Transfusion med. 1996 Oct: 21(5) : 310-4.

62. Shnider SM and Levinson G. Anaesthesia for obstetrics. Anesthesia 4th Edition; (Ronald D Miller MD) 61: 2030- 76

63. Shah JL, Bagulay I. Extradural pressure during labour. Br J Anaesth 1987; 59: 127.

64. Striebel HW, Holzl M, Wessel A. Sinle spinal anaesthesia versus continous spinal anaesthesia using th e Co SPAN catheter. Anesthesiologic, Intenstive medizine, Notfal medizine, Schmerx therapie. 1993 Aug; 28( 5): 292- 9.

65. Thomas DG, Robson SC Redforn N, Hughes D, Boys RJ. RAndomzed trial of bolus phenylephrine or ephedrine for maintenance of arterial pressure during spinal anaesthesia for caesarian section. British J. Anaesthesia 1996; 76( 1): 61-65.

66. Twigley AJ and Hillman KM. The end of the crystalloid era? A new approach to perioperative fluid administration. Anesthesia 1985; 40: 860.

67. Von Bormann B, Volume Substitution in acute normavolemic hemodilution. 5% human albumin Vs 6% hydroxyethyl starch. Infusions therapies 1990; Jun; 17(3): 142- 6.

68. Vogt NH, Bothner V, Lerch G, Lindener KH, Georgieff. Large dose administration of 6% hydroxy ethyl starch 200/0.5 in total hip arthroplasty: plasma homeostatis, hemostatis and renal function compared to use of 5% human albumin Anesh Analg 1996 Aug: 83(2) 262-8.

69. Wollman SB; Marx GF. Acute hydration for prevention of hypotension of spinal anaesthesia in parturients. Anesthesiology 1968; 29: 374- 380.

70. Wylie and Churchill- Davidson- Physiological changes of Pregnancy and Labour. A practice of Anasthesia. 5th edn; 38:1005-19.

71. W.S Chan, MG Ivwin, W.N. Tong and YH Lam. Prevention of hyptotension during spinal anaesthesia for caesarian section: Ephedrine infusion versus fluid preload. Anesthesia 1997, 52: 896- 913.

72. Yacobi A, Stroll RG, Sum CY. Pharmacokinetics of hydroxyethyl starch in normal subjects. J Clin Pharmacol 1982; 22: 206- 212.

73. Young DC, Popat R, Luther ER et al. Influence of maternal oxygen adminstration on the foetus before labour. Am J Obset & Gyna 1980; 136: 321.

74. Y.Hirabayashi, R Shimizu, H. Fukuda, K. Sitoh, and T. Igarashi. Effect of the pregnant uterus on extradural venous plexus in the supine and lateral position as determined by magnetic resonance imaging. Br. J. Anesth 1997; 78: 317- 319.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles