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Do warming iv fluids during the management of spinal- induced hypotension decrease the incidence of hypotension and reduce the amount of fluid, transfusion and ephedrine requirement?
Abstract Number: SA-13
Abstract Type: Original Research
Objective: This prospective, double-blinded, randomized, controlled study was undertaken to evaluate whether warming IV fluids (37 oC) resulted in lower incidence of hypotension, less ephedrine and transfusion requirement and lower fluid consumption than use of room-temperature fluids (22 oC) in cesarean delivery patients undergoing spinal anesthesia.
Methods: Following approval of faculty and ministry of health ethics committee and written informed patient consent, 63 healthy pregnant women undergoing elective cesarean delivery with spinal anesthesia were recruited. Parturients were allocated using computer generated random numbers and sealed envelopes to one of two groups as follows: Unwarmed fluid group (Group C, n=30) and warmed fluid group (Group W, n=30). Lactated Ringer’s infusions were launched at the maximal possible rate before the induction of spinal anaesthesia, in both groups. In order to maintain blinding, all hotline monitors and giving sets were covered in tubular bandage or invisible package, and all intravenous fluids were given via a Hotline fluid warmer which was only switched off in group C and switched on in group W. Maternal body temperature, hemodynamic parameters, the incidence of hypotension, fluid, ephedrine and transfusion requirements and side effects (bradycardia, hypoxemia, pain, shivering, nausea and vomiting) were recorded intraoperatively. After delivery, umbilical artery blood gas samples were taken and neonatal Apgar scores were recorded at 1 and 5 min by an attending pediatrician who was unaware of the patient group.
Results: Maternal body temperatures were significantly higher in the warm fluid group compared with the control group only at 15 min (p=0.02). There was no significant difference between the two groups in the incident of hypotension (70% (21/30), 56.7% (17/30) in group C and W, respectively),(p=0.42). Blood loss (p=0.63), fluid requirement (p=0.38) and ephedrine consumptions (p=0.11) were similar between two groups and no patient needed blood transfusion (Table 1). Six patients (20 %) in the control group and one patient (3.3 %) in warm group shivered and all required treatment with iv tramadol (p=0.1). No complication or major side effect related with spinal anaesthesia was recorded.
Conclusion: In cesarean section patients undergoing spinal anesthesia, warming IV fluids (37 oC) resulted in lower incidence of decreased core temperature but did not affect the incidence of maternal hypotension, ephedrine and transfusion requirement and total volume consumption.