Efficacy of Intravenous Fluid Plasmalyte and 6% Hetastarch in Preventing Spinal Anaesthesia Induced Hypotension in Patients undergoing Lower Abdominal Surgeries: A Randomised Clinical Study
Published: May 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/48211.14905
Prakriti Gupta, Suraj Kumar, Samiksha Parashar, Manoj Kumar Giri, Sujeet Rai, Deepak Malviya
1. Assistant Professor, Department of Anaesthesiology, T.S Misra Medical College, Lucknow, Uttar Pradesh, India.
2. Assistant Professor, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
3. Assistant Professor, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
4. Associate Professor, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
5. Associate Professor, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
6. Professor, Department of Anaesthesiology and Critical Care Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Correspondence
Anuradha Sekaran,
Mindspace Road, Gachibowli, Hyderabad, Telangana, India.
E-mail: dr.sanuradha@aighospitals.com
Introduction: Both crystalloids and colloid pre loading is recommended for spinal anaesthesia. Pre loading of intravenous fluids increases circulating volume and cardiac output; thus preventing spinal anaesthesia-induced hypotension. Crystalloids have a short intravascular half-life, poor plasma expanders and large volumes are thus required.
Aim: To compare the efficacy of 5 mL/kg of 6% Hetastarch (colloid) to that of 15 mL/kg of Plasmalyte (crystalloid) solution to prevent hypotension during spinal anaesthesia in patients undergoing lower abdominal surgeries.
Materials and Methods: This was a randomised clinical trial from June 2016 to April 2017 on a total 80 patients, belonging to American Society of Anaesthesiologist (ASA) Grade I and II scheduled for lower abdominal surgeries under spinal anaesthesia. They were divided into two groups- Group H and Group P. Patients in group H were preloaded with 5 mL/kg solution of 6% Hetastarch, whereas those in group P were preloaded with 15 mL/kg of Plasmalyte solution. After institution of spinal anaesthesia with 3.0 mL of hyperbaric bupivacaine using 25 G Quincke’s needle, Blood Pressure (BP) and other vital parameters were monitored intraoperatively every 3 minutes for first 30 minutes and then every 5 minutes till the end of surgery. Descriptive statistics, frequency and percentages were calculated and the variables between the groups were compared by Students t-test, Fischers-exact test and Mann Whitney U-test.
Results: Both the groups showed a fall in Mean Blood Pressure (MBP) immediately after the block. Group P showed more decline in MBP and Diastolic Blood Pressure (DBP) after the block and the difference was statistically significant at 9, 12, 15, 18 and 21 minute (p-value <0.05). A 30% patients in groupP as comparison to 10% in Group H required ephedrine for the treatment of hypotension and found significant (p-value=0.025). Systolic Blood Pressure (SBP), pulse rate changes and nausea and vomiting among both groups was non-significant (p-value >0.05).
Conclusion: Pre loading with 5 mL/kg of 6% Hetastarch is more effective than 15 mL/kg of Plasmalyte in preventing hypotension in patients undergoing lower abdominal surgeries under spinal anaesthesia.
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