British Journal of Anaesthesia, Vol 75, Issue 5 531-535, Copyright © 1995 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. Karinen, J. Rasanen, S. Alahuhta, R. Jouppila and P. Jouppila
We have studied the effects of crystalloid 1 litre (lactated Ringer's) or
colloid 0.5 litre (hydroxyethyl starch) preloading in 26 healthy
parturients undergoing elective Caesarean section under spinal anaesthesia.
Maternal placental uterine artery circulation was measured using a pulsed
colour Doppler technique with simultaneous measurement of maternal
haemodynamics. A high incidence of maternal hypotension was observed during
spinal anaesthesia in the crystalloid group (62%) but the incidence was
lower in the colloid group (38%). Central venous pressure was increased
significantly in both groups after preload but decreased shortly after
induction of spinal anaesthesia to baseline values. The mean pulsatility
index (PI) in the uterine arteries did not change during preload or spinal
block. A surprising finding was the widespread variation and some high
values for the uterine artery PI after spinal anaesthesia. These individual
increases in PI were transient and always returned to baseline values
within 2 min. These results suggest that preloading with either solution is
ineffective in preventing maternal hypotension and that changes in maternal
heart rate, systolic arterial pressure and central venous pressure during
spinal anaesthesia were not associated with rapid individual increases in
uteroplacental vascular resistance. These changes seemed not to have any
major effect, however, on the clinical condition of the newborn, as
assessed by Apgar scores and umbilical artery pH values.
CLINICAL INVESTIGATIONS
Effect of crystalloid and colloid preloading on uteroplacental and maternal haemodynamic state during spinal anaesthesia for caesarean section
Department of Anaesthesia, Oulu University Central Hospital, Kajaanintie 52 A, FIN-90220 Oulu, Finland; Department of Obstetrics and Gynaecology, Oulu University Central Hospital, Kajaanintie 52 A, FIN-90220 Oulu, Finland
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