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Effect of oral rehydration therapy for preventing hypotension after spinal anesthesia for cesarean section
Abstract Number: S 7
Abstract Type: Original Research
Background. Preoperative fasting from the day before surgery has been a standard practice to prevent aspiration pneumonia in pregnant women undergoing elective cesarean section under spinal anesthesia . Recent studies have shown that clear fluid is safely administered to those before cesarean section . Oral rehydration is effective for treating dehydration, suggesting that it is also effective for maintaining the volume of extracellular fluid in pregnant women. It would also improve patients’ satisfaction by preventing preoperative thirsty. However, there have been no studies examining the effect of oral rehydration therapy in pregnant women. We tested the hypothesis that oral rehydration therapy prevents a decrease of blood pressure as well as harmful side effects during spinal anesthesia for cesarean section in pregnant women.
Methods. We analyzed 260 pregnant women with ASA physical status I or II undergoing elective cesarean section under spinal anesthesia were randomly allocated to groups C and ORT (n = 120 and 140, respectively). Women in group C did not drink after midnight on the day of cesarean section. Women in group ORT was allowed to drink clear fluid until 3 hours before anesthesia, and consumed rehydration solution 500 ml 3 hours before anesthesia. The oral rehydration solution was 500 ml of clear water with OS-1® (glucose 1.8 %, sodium ion 50mEq/L, osmotic pressure 270 mOsm/L; Otsuka Pharmaceutical). Spinal anesthesia was performed with bupivacaine 11 mg, and vasopressor bolus was administered when mean blood pressure decreased below 70 mmHg. Patients’ satisfaction was evaluated postoperatively by anesthesiologists who were unaware of the group allocation using a 5-grade scale. Primary outcome was the times of using vasopressor used for treating hypotension and the secondary outcome was the patients’ satisfaction. Statistical analysis used was student’ T and χ２test. P<0.05 was regarded as statistically significant.
Results. There were no significant differences in the patients background data, neonatal Apgar score or the incidence of postoperative nausea and vomiting between the two groups. The frequency of vasopressors used was significantly smaller (83.4% vs 66.1%, P = 0.02) in group ORT than those in group C and patients’ satisfaction was high in group ORT.
Conclusions. Oral rehydration therapy with rehydration solution 3 hours before anesthesia and to allow to intake clear fluid until 3 hours before anesthesia and is effective for preventing the incidence of hypotension after spinal anesthesia and improves patients’ satisfaction. In addition, ORT does not adversely affect the neonate and is safe for the patient.
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2. Wong CA, Loffredi M, Ganchiff JN, Zhao J, Wang Z, Avram MJ. Gastric emptying of water in term pregnancy. Anesthesiology. 2002;96:1395-400