Abstract

*Dr. Pandav Amol and Dr. Kelkar V.S.

ABSTRACT

Background: Maternal hypotension, the most frequent complication of spinal anesthesia for caesarean section, can be associated with severe nausea and vomiting which can pose serious risk to mother and neonate. Acute hydration with crystalloid prior to initiation of block for prevention of hypotension has been established as a routine. Although volume prehydration may reduce the incidence of spinal induced hypotension, it does not reliably prevent it. In this context, the present study was designed to test the hypothesis that rapid administration of crystalloid at the time of induction of spinal anaesthesia (co-load) is associated with less hypotension than preload. Objective: Comparison of crystalloid preloading and rapid crystalloid co-loading for control of spinal anesthesia induced hypotension during lower segment caesarian section. Methods: 80 patients of ASA I and II with singleton pregnancy were randomly allocated to equal groups of 40 each to receive either crystalloid pre-load or a co-load. Hypotension was defined as a decrease in systolic arterial pressure of more than 20% from the baseline or to less than 100mmHg as absolute value, which was treated by rapid i.v. fluid, Oxygen and boluses of phenylephrine in dose of 1?g/kg if required. Results: Regarding the incidence of hypotension between the pre-load and the co-load group, maximum episodes were found in pre-load group (72.5%) and only 27.5% in the co-load group. The difference was statistically significant (P < 0.01).Also there was no evidence of use of vasopressor required to correct hypotension in coload group. Conclusion: A significantly lower incidence of hypotension was found in co-load group than preload group and severity of hypotension demanding vasopressor use was noted only in preload group.