A Comparison of Using Crystalloid Preloading and Co-Loading in Caesarean Section Operation Under Spinal Anaesthesia and Its Association with Spinal Anaesthesia Induced Hypotension and Heart Rate Variability

Abstract

Context: There is lack of evidence on comparison of crystalloid pre-loading and co-loading in parturients undergoing cesarean section operation under spinal anesthesia in Bangladesh. Hence, the present study was designed to compare the efficacy of crystalloid pre-loading and co-loading in preventing spinal anesthesia induced hypotension and heart rate variability during caesarean delivery.
 Methods: This single blinded randomized controlled clinical trial was conducted in the Department of Anaesthesia, Analgesia & Intensive Care, Dhaka Medical College Hospital, Dhaka, Bangladesh, from January 2013 to December 2014. A total of 90 patients were selected - 45 patients of group I received co-loading with Ringer’s lactate solution, while another 45 patients of group II received a pre-loading with the same fluid. Blood pressure and heart rate were recorded in both the groups with 3-minute intervals from the beginning of the subarachnoid block for the first 20 minutes, and then with 5-minute intervals up to one hour. Ephedrine was used as the primary rescue drug to treat hypotension. When ephedrine failed to treat hypotension, adrenaline was administered as a potent vasopressor.
 Results: The incidence of hypotension was 17 (37.8%) in group I (co-loading group) and 27 (60%) in group II (pre-loading group), which was significantly higher in group II (p<0.05). Comparatively higher heart rate was observed in group II, but not statistically significant. Ephedrine was required in 17 cases (37.8%) in group I and 27 cases (60%) in group II. Mean ephedrine required was 9.2±3.6 mg in group I and 11.5±4.3 mg in group II. The difference was statistically significant (p<0.05). Adrenaline was administered in 1 case (2.2%) in group I and in 2 cases (4.4%) in group II, which was not statistically significant (p>0.05).
 Conclusion: Severity of hypotension and increased ephedrine requirement were evident in patients who received crystalloid pre-loading (group II), which means crystalloid co-loading (group I) was more capable to prevent spinal anaesthesia induced hypotension.
 J Dhaka Medical College, Vol. 29, No.1, April, 2020, Page 12-17