A Comparison of Crystalloid Preloading and Co-Loading to Prevent Spinal Anaesthesia Induced Hypotension in Caesarean Section

Abstract

Background: Preloading of crystalloid is a traditional practice to prevent spinal anaesthesia inducedhypotension. But co-loading seems to be more physiological and rational approach as effect was achievedduring the time of spinal anaesthesia.

Aims: To compare the efficacy of crystalloid preloading and co-loading for prevention of hypotensionduring spinal anaesthesia in caesarean section.

Methods: This study was conducted in Department of Anaesthesia, Analgesia and Critical Care, CombinedMilitary Hospital (CMH), Chittagong. Study was carried out over a period of six months from January toJune 2017. Total 80 patients (40 in each group) were included in this study. Patients with ASA grade 1& 2, aged 18-40 years were included. Patients with complicated pregnancy or failed spinal were excluded.Group-P (Preload group) received 15ml/kg Crystalloid solution (Hartmann’s solution/lactated Ringer’ssolution), 20 min before administration of spinal anaesthesia. Group-C (Co-load group) received bolus of15 ml/kg Crystalloid solution (Hartmann’s solution /lactated Ringer’s solution) at time of administrationof spinal anaesthesia. Blood pressure was recorded at 1, 2, 3, 5 & 10 minutes. Patients received vasopressorswhen mean blood pressure reduced below 20 mm of Hg or systolic blood pressure dropped below 90mmHg.

Results: Total study population was 80 patients underwent caesarean section. Mean age of the patientswas 28.36±5.08 years and 28.25±5.06 years in group-P and C, respectively. Overall hypotension was notedin 23 patients (57.5%) of group-P and 19 patients (47.5%) of group-C. The difference between two groupswas statistically insignificant (p=0.241). After induction of spinal anaesthesia at 1 minute hypotensionwas noted in 7 patients (17.5%) of group-P and in 13 patients (32.5%) of group-C, at 2 minutes in 21patients (52.5%) of group-P and in 22 patients (55%) of group-C, at 3 minutes in 23 patients (57.5%) ofgroup-P and in 24 patients (60.0%) of group-C, at 5 minutes in 17 patients (42.5%) of group-P and in 19patients (47.5%) of group-C, at 10 minutes in 13 patients (32.5%) of group-P and in 7 patients (17.5%) ofgroup-C hypotension was developed.

Conclusion: Both preloading and co-loading with 15 ml/kg of Crystalloid solution (Hartmann’s solution/lactated Ringer’s solution) when used alone, are ineffective for the prevention of hypotension in caesareansection receiving spinal anaesthesia. We recommend frequent monitoring of maternal blood pressure andprompt treatment of maternal hypotension with vasopressors for better neonatal outcomes.

JBSA 2017; 30(2): 83-89