A Comparative Efficacy of Lactate Ringer Solution Preloading, Co-loading, and Pre- and Co-loading to Prevent Hypotension after Spinal Anesthesia in Elective Cesarean Section
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Abstract
Background: Hypotension after spinal anesthesia is a most frequent complication around 60-70% in maternal undergoing caesarean section. Practical way to overcome or prevent hypotension due to spinal anesthesia is administering intravenous fluid boluses. This study aimed to compare the effectiveness of lactate ringer solution preloading, co-loading and preloading with co-loading (pre & co-load) against the incidence of hypotension after spinal anesthesia in elective caesarean section. Methods: This research is randomized clinical control trial. The number of subjects who participated in this study were total 147 subjects 49 subjects per group. Maternal subjects aged over 18 years who planed undergo elective cesarean section with spinal anesthesia and there were no contraindications for spinal anesthesia were enrolled. Participants were randomized into three groups, preload co-load and pre & co-load group. Systolic blood pressures, diastolic blood pressures, mean arterial pressure, and pulse rate are measured in basal conditions and every 1 to 15 min after spinal anesthesia and every 5 min until surgery were completed. Comparing incidence of post spinal anesthesia hypotension, maternal clinical complications, proportion of received vasopressors with exact probability test, comparing blood pressure level, heart rates, amount of vasopressors, duration of surgery, amount of intravenous fluid, neonatal status and birth weight was determined by ANOVA. Comparison incidence of hypotension after spinal anesthesia among three groups by Hazard ratio with COX-regression analysis. Results: There was no difference in ages, gestational ages, BMI and pre-operative blood pressure among three groups. Incidence rate of post-spinal block hypotension was 10.5, 12.0 and 6.3/100 person-hours in preload, co-load and pre & co-load respectively. Hazard ratios were 0.61 (0.42, 0.90) and 0.48 (0.32, 0.71) for pre & co-load group when comparative group was preload and co-load respectively. Conclusion: Lactate Ringer solution pre & co-load was significantly better in reducing incidence of hypotension after spinal anesthesia in elective cesarean section compared with the preload and co-load groups. Considering for pre & co-load for first line of lactate ringer intravenous administration in maternal elective cesarean section.
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