Azmat Riaz, Zeba Munzar.
Preloading before spinal anesthesia for Cesarean section. a comparison between colloid and crystalloid preload.
Anesth Pain Intens Care Jan ;10(1):9-12.

Objective: To compare the preloading effect of 500 ml hydroxyethyl starch (HES) 6% with 1000 ml of Ringer`s lactate to prevent hypotension in spinal anaesthesia for elective cesarean section. Design: Randomized clinical trial Place and duration of study: PAF hospital Islamabad, from November 2005 to March 2006. Patients and methods: The trial was conducted in two groups of healthy women, scheduled to have elective cesarean section with no fetal compromise. The first group received HES 6% 500 ml (HES group) (n =25) and the second group was infused with 1000 ml Ringer`s lactate (RL group) (n=25), in 15 minutes before administering spinal anaesthesia. The incidence of hypotension (systolic B.P < 90 mm Hg or < 80% of baseline), and incidence of nausea and / or vomiting were recorded. Neonatal outcome was assessed by apgar scoring at 1, 5 and 10 min. Results: The incidence of hypotension was lower in HES group than RL group. Hypotension occurred in 9 out of 25 women (36 %) who received HES 6%, while 15 out of 25 women (60 %) of RL group developed hypotension. The incidence of nausea and or vomiting was also lower in HES group (24% vs. 40%). Neonatal outcome was good and similar in both groups. Conclusion: Preloading pregnant ladies undergoing elective cesarean section, with 500 ml HES 6%, 15 min before induction of spinal anaesthesia decreases the incidence of hypotension more than preloading with 1000 ml Ringer`s lactate.

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