EFFECT OF PRELOADING V/S COLOADING OF CRYSTALLOID INFUSION ON MATERNAL HYPOTENSION AFTER SPINAL ANESTHESIA FOR ELECTIVE CESAREAN SECTION: A RANDOMISED COMPARATIVE STUDY

Abstract

Background: Spinal anesthesia induced hypotension is a major complication in parturient. Intravenous crystalloids administration is a routine practice to prevent and treat maternal hypotension. However, timing of infusion is yet to be determined. We therefore compared preloading with coloading to determine the optimal timing of infusion for prevention of maternal hypotension post spinal anaesthesia. Methods: Seventy parturients were randomized to receive 15ml/kg of crystalloid before (preload group) or after (coload group) intrathecal drug injection for spinal anesthesia. Primary objectives of this study were to look for incidence of intra operative hypotension and total dose of ephedrine used, while secondary objectives were hemodynamic variables, neonatal outcome (apgar scores) and the incidence of maternal nausea and vomiting. Data were expressed as mean (SD) or number (%) as indicated and were compared using chi-square, sher's exact, or student's t test as appropriate. Results: Parturient in preload group (PL) had higher incidence of spinal anesthesia induced hypotension (85.71%) as compare to coload group (CL) (65.71%) but the difference was statistically insignicant(p=0.051). Lower doses of ephedrine were used in coload group median 6 mg (range 0-24mg) then preload group median 12 mg (range0-24mg) p=0.0002. Nausea and vomiting were lower in coload group (14.29%) as compare to preload group (20%) but were statistically insignicant. Apgar score was comparable between both groups. Conclusion: Crystalloid are recommended at the time of block (coload) in parturients undergoing spinal anesthesia to prevent post spinal maternal hypotension and vasopressor requirement.