Intravenous Albumin Administration for Prevention of Spinal Hypotension during Cesarean Section

Mathru, M.; Rao, Tadikonda L. K.; Kartha, R. K.; Shanmugham, M.; Jacobs, H. Kurt

doi:10.1213/00000539-198009000-00003

Cited by 59 publications

(37 citation statements)

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“…There was no hypotension in albumin group compared to 29% in the crystalloid group. 6 We found an incidence of 18% in hydroxyl ethyl starch group.…”

Section: Discussionmentioning

confidence: 58%

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Singh

Linus

2017

Int J Res Med Sci

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Background: Arterial hypotension following spinal anesthesia still remains the leading cause for maternal mortality and morbidity. Active management of hypotension and more so its prevention of its ads more safety value to spinal anesthesia, which is widely practiced worldwide. Preloading of patients with either crystalloid or colloid prevents the severity of hypotension. Objectives of the study was to compare the preloading efficacy of Ringers lactate solution (20 ml/kg) and 6% hydroxyl ethyl starch at 10 ml/kg in prevention of hypotension following spinal anesthesia in elective caesarean section.Methods: 100 ASA grade I and grade II subjects for elective caesarean section were studied in two groups. Group A (Ringer lactate group) 50 subjects and Group B (hydroxyl ethyl starch group) 50 subjects. Each group was preloaded over a period of 20 minutes before spinal anesthesia with either ringer lactate solution (Group A) at 20 ml/kg or 6% hydroxyl ethyl starch group at 10 ml/kg body weight. Main outcome measures were mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate.Results: Demographic characteristics of both groups were comparable. Incidence of hypotension was significantly more in ringer lactate group. There was no significant difference of heart rate in both the groups. No allergic reaction was noted to hydroxyl ethyl starch. Vasopressor requirement was also low in hydroxyl ethyl starch group compared to ringer lactate group.Conclusions: Preloading subjects with 6% hydroxyl ethyl starch is beneficial than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.

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“…There was no hypotension in albumin group compared to 29% in the crystalloid group. 6 We found an incidence of 18% in hydroxyl ethyl starch group.…”

Section: Discussionmentioning

confidence: 58%

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Singh

Linus

2017

Int J Res Med Sci

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“…Albumin (5%) in combination with dextrose 5% is more effective in sustaining maternal blood pressure than dextrose alone or even dextrose plus prophylactic intramuscular ephedrine [12]. However, albumin is a relatively expensive colloid and, recently, attention has been drawn to possible morbidity associated with its use [13].…”

Section: Discussionmentioning

confidence: 99%

“…This is due to the underestimation of the incidence of venous thromboembolism and to the fear of creating an increased risk for intracranial bleeding [9±11]. Physical methods such as graduated compression stockings and intermittent pneumatic compression (IPC) devices give a worthwhile reduction of venous thromboembolism [12,13] but there still remains a substantial residual incidence. Inappropriate use of these methods, because of the nature or site of the injuries, may lead to a failure of DVT prophylaxis.…”

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confidence: 99%

Anaesthesia for insertion of bone‐anchored hearing aids in children: a 7‐year audit

Jones¹,

Dickson

Moriarty³

2001

Anaesthesia

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SummaryForty-three children, aged 23 months to 14 years, received 102 anaesthetics for insertion of boneanchored hearing aids, each lasting approximately 30±60 min. Forty of the children had a recognised syndrome involving the head and neck, including Goldenhar's and Treacher Collin's syndrome. The incidence of congenital heart disease was 19%. Pre-existing conditions, anaesthetic technique, grade of intubation, complications and discharge were audited. Sixteen of the patients were classified as Grade 3 or 4 intubations. Over the 7 years, laryngeal mask airway usage increased for airway maintenance rather than tracheal intubation, as did the use of propofol for induction rather than inhalational methods. Intra-operative complications (5.9%) were related to the airway, and postoperative ones (17.6%) mainly to nausea and vomiting. Surgery was performed as a day case in 71% of the patients despite some long-distance travel. Children with conductive deafness are usually fitted with conventional hearing aids at an early age. This is impossible in children with congenital absence of the ears or external auditory canals, and in those with a chronic suppurative discharge.Unilateral microtia may be associated with various malformations involving the first and second branchial arch such as Goldenhar's syndrome (oculoauricularvertebral syndrome) [1]; 20% of children with Goldenhar's syndrome also have congenital heart disease. Bilateral microtia is often associated with Treacher Collin's syndrome (mandibular dysostosis) along with micrognathia, aplastic zygomatic arches, microstomia and choanal atresia [2]. Abnormalities of the auditory canals are sporadically found among children with other craniofacial and musculoskeletal abnormalities.The fitting of a bone-anchored hearing aid (BAHA) in these children, especially if performed early, allows them to hear and develop normal speech. BAHAs rely on osseointegration, which is defined as direct contact between living bone and a loaded implant surface. They were developed first in Sweden in 1977 [3] following earlier work involving fixation of missing teeth. The suitability of a patient to be fitted with a BAHA requires extensive multidisciplinary assessment. There should be maximal conductive hearing loss, and good cochlear reserve. A limiting factor is age as bone thickness may not be adequate before 2 years of age.The surgery involves two operations, each lasting 30± 60 min. The patient is supine with the head slightly raised and tilted to one side, supported by a sandbag. A titanium fixture, 3±4 mm in diameter, is implanted into the mastoid bone behind the ear. Frequently, two are inserted to allow for failure or traumatic loss. After 3±6 months, osseointegration should have occurred and at the second operation the skin flap over the implant is thinned and an abutment, designed to carry the hearing aid, is placed over the fixture. After healing, the hearing aid is fitted in outpatients. The overall failure rate, with two fixtures, in Birmingham is 8% [4]. 777BAHA surgery w...

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“…Prevention of hypotension is more desirable than correction, as without preventive measures the incidence of hypotension can be as high as 90%. 1 Additional measures were tried with varying success, such as intravenous (IV) infusion of 5% albumin in 5% dextrose in Ringer's lactate, 15 mL/kg, 2 IV boluses of ephedrine, 3 IV infusion of dopamine, 4 and IV ephedrine infusion. 5,8 Fluid coloading appears to be more physiological and rational approach as the maximal effect can be achieved at the time of onset of the block.…”

Section: Introductionmentioning

confidence: 99%

Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

2017

The Journal of Medical Sciences

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Introduction: Spinal anesthesia is widely used in the management of uncomplicated cesarean section. Maternal hypotension is the commonest serious problem which decreases uterine blood flow causing fetal hypoxia, acidosis, and neonatal depression. Fluid administration before start of the surgery (preloading) with crystalloid is found to be ineffective due to rapid redistribution of fluids in various tissue spaces. A "coload" given at the time of spinal anesthesia may be more effective. Most studies have concentrated on noninvasive systolic blood pressure (SBP) measurements to evaluate the effect of such regimens. We used central venous pressure (CVP) measurement technique in parturients receiving rapid administration of crystalloid or colloid solution at the time of initiation of anesthesia (coload). We hypothesized that a colloid coload compared with a crystalloid coload would produce a larger sustained increase in volume and therefore reduce vasopressor requirements. Materials and methods:We recruited healthy term women scheduled for elective cesarean delivery under spinal anesthesia for this randomized study. Baseline heart rate, baseline mean arterial blood pressure (MAP), and CVP were recorded. At the time of spinal injection, subjects were allocated to receive a rapid 1 L coload of either polymerized gelatin 3.5% (Haemaccel) or Hartmann (crystalloid) solution. The primary outcome CVP was compared between groups, as were secondary outcomes: phenylephrine dose and maternal hemodynamics data.Results: Maternal demographics, surgical times, and American Society of Anesthesiologists (ASA) were similar between groups. Baseline parameters were similar in all the three groups. Heart rate increased from the baseline in all the three groups; however, mean heart rate was highest in crystalloid group. Mean arterial blood pressure decreased in all the three groups from baseline; however, highest fall was recorded in crystalloid group. The incidence of hypotension was 66.66% in crystalloid group as compared with 36.66% in colloid group. Crystalloid group patients received 6.33 ± 4.54 mg of ephedrine as compared with 2.40 ± 2.82 mg in colloid group. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in crystalloid group as compared with colloid group. We found statistically significant differences in the mean preoperative CVP reading (p < 0.05) between the two groups, the mean CVP reading in crystalloid group being slightly lower. With preloading, similar CVP readings were obtained in both groups. The fall in CVP during subarachnoid blockade was also not significant. The CVP began to fall with the establishment of the block until the delivery of the baby after which it was found to rise. The predelivery CVP was significantly lower than preoperative CVP in both groups-the fall being significantly more in crystalloid group. Conclusion:In our study, the results showed statistically significant decrease in volume requirement, when colloid coload is used than crystalloid coload using C...

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Intravenous Albumin Administration for Prevention of Spinal Hypotension during Cesarean Section

Cited by 59 publications

References 0 publications

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Comparative study of Ringer’s lactate solution and 6% hydroxyethyl starch solution as pre-loading fluid for prevention of hypotension following spinal anesthesia

Anaesthesia for insertion of bone‐anchored hearing aids in children: a 7‐year audit

Crystalloid Coload vs Colloid Coload following Spinal Anesthesia for Elective Cesarean Delivery: The Effects on Maternal Central Venous Pressure

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