Comparative Evaluation of Preloading with Dextran, Hydroxyethyl Starch, Polygelatine and Ringer Lactate for Prevention of Hypotension Following Spinal Anaesthesia
Background: A good number of routine and emergency surgical procedures are done under spinal anaesthesia. Hypotension is the most common cardiovascular response of spinal anaesthesia which may be associated with serious patient discomfort and mortality. Preloading has proved to be the most effective method for prevention of post spinal hypotension. Preloading is rapid administration of crystalloid or colloid solution before giving spinal or epidural block.Aim: To study the effect of pre-operative infusion of Ringer Lactate, Hydroxyethyl starch, Dextran 40 and Polygelatine to prevent spinal hypotension and compare the effect of preloading with different colloids. Material & Methods: 100 patients, ASA physical status of I and II undergoing elective surgeries between the age group of 21 to 60 years were randomized into four groups depending upon the type of fluid (Hydroxyethyl starch, Dextran-40, Polygelatine and Ringer Lactate) used for preloading the patients before the subarachnoid block. In case of hypotension, Inj. Mephentermine(3mg) was injected to maintain blood pressure. The number of boluses of Inj. Mephentermine were recorded. Results: Incidence of hypotension in group R preloaded with Ringer lactate solution is 56%, group H preloaded with HES is 24%, group D preloaded with Dextran 40 is 32% and group P Polygelatine is 36%. This was statistically found to be highly significant (p<0.001). when compared between groups, it was also observed that the use of mephenteramine as vasopressor was minimum in Hydroxyethyl Starch (HES) group as compair to the Ringer Lactate, Dextran and Polygelatine groups. The use of mephentermine was found higest in the Ringer lactate group. Conclusion: Subarachnoid block is associated with significant incidence of hypotension. In prevention of post subarachnoid block hypotension preloading with Hydroxyethyl Starch (HES) is more effective than the Ringer Lactate, Dextran and Polygelatine
