PREVENTION OF HYPOTENSION AFTER SPINAL-ANESTHESIA FOR CESAREAN-SECTION - 6 PERCENT HETASTARCH VERSUS LACTATED RINGERS SOLUTION

This study was designed to determine whether preoperative administrati on of 6% hetastarch decreases the incidence and severity of hypotensio n after spinal anesthesia for cesarean section. Forty nonlaboring ASA class I and II women having nonurgent cesarean sections were randomize d to receive either 500 mL of 6% hetastarch plus 1 L lactated Ringer's solution (LR) (n = 20), or 2 L of LR (n = 20) prior to induction of s pinal anesthesia. Hypotension occurred in 45% of patients who received hetastarch vs 85% of those who received only LR (P < 0.05), and minim um systolic blood pressure was lower in the LR group than in the hetas tarch group (85 +/- 12 vs 93 +/- 12 mm Hg [mean +/- SD]; P < 0.05). In addition, the LR group had a higher maximum heart rate (115 +/- 17 vs 104 +/- 16 bpm), a shorter mean time to hypotension (7 +/- 4 vs 10 +/ - 7 min), and required more 5-mg doses of ephedrine for treatment of h ypotension (0 vs 2 [median]; P < 0.05) than the hetastarch group. Neon atal outcome, as determined by Apgar scores and cord blood gas analyse s, was good and similar in both groups. We conclude that 6% hetastarch plus LR is more effective than LR alone and that its routine use befo re spinal anesthesia for cesarean section should be considered.