Practice of spinal anaesthesia in a developing country: usefulness of 7.5%hypertonic saline preloading.

Objective: To assess the efficacy of hypertonic saline for prevention of ar terial hypotension in patients undergoing spinal anaesthesia in Niger. Study design Prospective, randomized, double-blinded study. Patients: Fifty adults undergoing scheduled surgery under spinal anaesthesi a, allocated either to a hypertonic saline group (HSG) or a isotonic saline group (ISG). Methods: Over the 15 min prior to anaesthesia, 100 mt of 7.5% saline were i nfused in patients of HSG, and 100 mt of 0.9% saline in those of ISG respec tively. Spinal anaesthesia was performed at the L3-L4 or L4-L5 interspace u sing either lidocaine 5%, or bupivacaine 0.5% or a mixture of both suppleme nted with fentanyl. Arterial pressure (AP) and heart rate (HR) were measure d the day before surgery, prior to and after spinal anaesthesia, thereafter every 5 min over 30 min and every 10 min thereafter until completion of su rgery. Hypotension 30% decrease of systolic AP control value was treated wi th 500 mt of Ringer lactate solution and in case of failure with ephedrine (5-30 mg IV). An isolated bradycardia (HR < 60 b.min(-1)) was treated with atropine (0.5-1 mg IV). Results: Hypotension occurred in two out of 24 patients of the HSG and eigh t out of 24 of the ISG (P < 0.05). The mean infused volumes of Ringer lacta te solution were 387 +/- 218 mt vs 623 +/- 318 mt respectively (P < 0.95). Ephedrine and/or atropine were not required in HSG, however in 7 out of the 24 patients of the ISG. Adverse clinical effects did not occur. Conclusion: Hypertonic saline prevents efficiently the occurrence of hypote nsion during spinal anaesthesia. Considering its ease of preparation, the l ack of adverse effects, in patients not suffering arterial hypertension or congestive heart failure. and low cost, hypertonic saline is well adapted f or use in a developing country, if isotonic solutions are not available. (C ) 1999 Elsevier, Paris.