Effect of Crystalloid or Colloid Fluid Loading and Vasopressor Pre-Treatment on the Timing of Hypotension in Cesarean Section with Subarachnoid Block

Syafruddin Gaus; Muhammad Irfan Djafar; Andi Salahuddin; Muhammad Ramli Ahmad; Andi Muhammad Takdir Musba; Ari Santri Palinrungi

doi:10.3889/oamjms.2022.10860

Authors

Syafruddin Gaus Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Muhammad Irfan Djafar Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Andi Salahuddin Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Muhammad Ramli Ahmad Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Andi Muhammad Takdir Musba Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
Ari Santri Palinrungi Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.10860

Keywords:

Cesarean section, Subarachnoid block, Crystalloids, Colloids, Vasopressor

Abstract

BACKGROUND: Cesarean section (C-section) is the most frequently performed surgery in obstetrics, generally using subarachnoid block (SAB) or epidural block for anesthesia. The previous studies have shown the effectiveness of fluid loading and vasopressor pretreatment in preventing maternal hypotension (decreased blood pressure), the most common side effect of SAB. However, the timing of hypotension in response to these treatments has not been analyzed.

AIM: This study therefore aimed to compare the effects of crystalloid or colloid fluid loading and vasopressor pre-treatment on the timing of hypotension in cases of C-section under SAB anesthesia.

METHODS: The study was a single-blind randomized controlled clinical trial with three treatment groups: Group I, 10 mL/kgBW crystalloid solution (Ringer’s lactate) loading 10 min before SAB; Group II, 5 mL/kgBW colloid fluid (gelatin) loading 10 min before SAB; and Group III, pretreatment with 0.1 mg/kgBW vasopressor (ephedrine) intravenous bolus just before SAB.

RESULTS: Significant differences in mean blood pressure between groups were observed between the second and 8^th min (p < 0.05). Hypotension was observed in the crystalloid group within the first 5 min, while average blood pressure was relatively stable all groups after the first 10 min. In addition, hypotension occurred more frequently in the crystalloid group (nine subjects, 45%), compared with the colloid and vasopressor groups (two subjects per group, 10%; p < 0.05).

CONCLUSION: Hypotension occurred more rapidly and more frequently when crystalloid loading was utilized, compared with colloid loading or vasopressor pretreatment. Administration of colloid fluid loading and vasopressor pretreatment has been shown to prevent hypotension in SAB anesthesia.

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