IJSR - International Journal of Scientific Research

Dr. Suresh Kumar; Dr. R.C. Sunar; Dr. Farooq Maniyar

Volume : VI, Issue : IV, April - 2017

A Comparative Study of Preload versus Coload by crystalloid for Parturients undergoing caesarean section under spinal anaesthesia

Dr. Suresh Kumar, Dr. R. C. Sunar, Dr. Farooq Maniyar

Abstract :

Background: Prophylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during caesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because of its short stay in intravascular space.

Methods: In this prospective controlled study, seventy parturients were randomised to receive 15 ml/kg of crystalloid before (preload Group A) or after (coload Group B) intrathecal drug injection for spinal anaesthesia. Maternal hypotension was defined as a decrease in SBP to more than 20% of the baseline of SBP value. Hypotension was treated with crystalloid boluses and 6 mg mephentermine was given intravenously every 3 min, until the SBP recovered to the baseline value. Bradycardia was defined as a HR less than 50 beats/minute. Blood pressure, heart rate, nausea, vomiting and shivering were assessed. Neonatal outcomes were evaluated with Apgar scores.

Results: The incidence of hypotension was lower in the Group B compared to the Group A (62.86% vs. 77.14%, P=0.29 NS) and was comparable statistically. More number of patients developed nausea (11 vs 3, P = 0.036 S) and vomiting (2 versus 0, P = 0.47 NS) in group A as compared to group B. The mean total dose of mephentermine was used (8.91±5.118 mg and 5.66±4.814 mg in groups A and B respectively) in the groups was statistically significant.

Conclusions: Both preloading and coloading with 15 ml/ kg of RL solution are ineffective to the prevent spinal–induced maternal hypotension. Frequent monitoring of maternal blood pressure and prompt treatment of maternal hypotension with vasopressors recommended for better neonatal outcomes.