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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00


Abstract Number: 114
Abstract Type: Original Research

Brandi Bottiger M.D.1 ; Dmitri Bezinover M.D.2; Priti Dalal M.D.3; Jansie Prozesky M.D.4; Sonia Vaida M.D.5

Background: Hypotension induced by spinal anesthesia for cesarean delivery (CD) has a very high incidence. Preventing hypotension rather than treating hypotension after it occurs improves the neonatal acid-base status and reduces the incidence of maternal nausea and vomiting. Preloading with crystalloid has not been efficacious. Colloid preload proved to decrease but not abolish the incidence of hypotension. The aim of this study was to investigate whether the combination of phenylephrine infusion and colloid preload would be more effective in preventing hypotension after spinal anesthesia for CD than the combination of phenylephrine infusion with crystalloid preload.

Methods: Pregnant patients, ASA class 1 and 2 scheduled to undergo elective CD were randomly assigned to one of two groups: the crystalloid group received a preload of 1500 mL Ringers Lactate solution; the colloid group received a preload of 0.5 L hydroxyethylstarch 6%. Patients in both groups received 100 g/min phenylephrine infusion following spinal anesthesia which continued until uterine incision. The phenylephrine infusion was adjusted according to heart rate and systolic blood pressure (SBP) which was maintained at 20% of the baseline, and assessed every minute until uterine incision. Hypotension was defined 20% fall in SBP from baseline, and hypertension as an increase of 20% from the baseline. APGAR scores, total phenylephrine dose and incidence of nausea and vomiting were recorded. Incidence of bradycardia was recorded as a secondary outcome measure.

Results: 60 patients have been included as part of a 90 patient study (colloid group n= 32 and crystalloid group n= 28). 3 patients were excluded from the study. There was difference in the changes in SBP following the induction of spinal anesthesia, within and between the two groups. There was a significant decrease in the heart rate following induction spinal anesthesia within both groups (p<0.05). Higher cumulative dose of phenylephrine (1225 g 494.1) was necessary in the crystalloid group compared to the colloid group (1055 g502.2), although not statistically significant. The incidence of bradycardia was 25 % in the colloid group vs. 21.4 % in the crystalloid group was not statistically significant. The incidence of hypotension was 17.8% in the crystalloid group vs. 9.3% (p=0.4) in the colloid group. The incidence of hypertension was 7.1% in the crystalloid group and 18.76% (p=0.1) in the colloid group. The incidence of vomiting was 6.25% in crystalloid group vs. 3.57% in the colloid group. There was no difference in the one minute and the 10 minute APGAR scores in the two groups (p>0.05).

Conclusions: The preliminary results of this study show that colloid preload with a continuous phenylephrine infusion does slightly lower the incidence of hypotension and vomiting in comparison to crystalloid preload with a continuous phenylephrine infusion in patients undergoing spinal anesthesia for elective CD.

SOAP 2010