Prevention of hypotension after spinal anesthesia for cesarean section: 6% hydroxyethyl starch 130/0.4 (Voluven) versus lactated Ringer's solution

Abstract

Goals: The aim of this study is to compare the efficacy of HES 130/0.4, a new hydroxyethyl starch, to lactated Ringer's solution (LR) in the prevention of hypotension after spinal anesthesia for cesarean section (CS).

Material and methods: One hundred and twenty nonlaboring ASA I and II women having non urgent CS were enrolled in this prospective and randomized study. Subjects were randomly assigned to receive prior to anesthesia either 1 liter of LR (Gr I: n = 59) or 500 ml of HES 130/0.4 (Gr II : n = 61). Blood pressure was measured until discharge from the post anesthesia care unit. Hypotension was treated with i.v. boluses of 3 mg of ephedrine. The nausea scale was recorded. Arterial and venous umbilical blood gazes were obtained. Data were compared using Mann-Whitney U-test and Student's t-test (p < 0.05 was significant).

Results: Thirty-nine patients in Gr II while 48 pts in Gr I experienced hypotension (p = .033). The total dose of ephedrine was statistically smaller in Gr II compared with Gr I (p = .001). Nausea after induction of spinal anesthesia occurred with similar frequency in both groups. Neonatal outcome was excellent and similar in both groups.

Conclusion: HES 130/0.4 is more effective than LR to prevent hypotension following spinal anesthesia for CS; its routine use in this purpose should be considered.