EFFECTIVITY OF RINGER’S LACTATE COLOADING COMPARISON WITH HES 6% COLOADING IN PREVENTING HYPOTENSION AFTER LOW DOSE SPINAL ANESTHESIA IN CESAREAN DELIVERY.

Presentasi berjudul: "EFFECTIVITY OF RINGER’S LACTATE COLOADING COMPARISON WITH HES 6% COLOADING IN PREVENTING HYPOTENSION AFTER LOW DOSE SPINAL ANESTHESIA IN CESAREAN DELIVERY."— Transcript presentasi:

1 EFFECTIVITY OF RINGER’S LACTATE COLOADING COMPARISON WITH HES 6% COLOADING IN PREVENTING HYPOTENSION AFTER LOW DOSE SPINAL ANESTHESIA IN CESAREAN DELIVERY La Ode Abdul Syukur; Syamsul Hilal Salam ; Andi Husni Tanra Department of Anesthesiology, Intensive Care and Pain Management Faculty of Medicine – Hasanuddin University 3 rd Annual Symposium on Anesthesia Complications Spinal anesthesia is commonly used in pregnant women who will undergo cesarean delivery. The most common side effect that occurs is hypotension. Some procedures are used to prevent hypotension such as uterine lateral disposition, crystalloid or colloid loading, vasopressor prophylaxis and modified technique of spinal anesthesia. The aim of this research is to compare the effectivity between crystalloid coloading and colloid coloading to prevent hypotension after low dose spinal anesthesia. This research used a single-blind, randomized, controlled, in order to determine the effectiveness of Ringer Laktat (RL) coloading compared Hydroxyethyl Starch (HES) 6% coloading in preventing hypotension after low dose spinal anesthesia in patients undergoing cesarean delivery Spinal anesthesia is commonly used in pregnant women who will undergo cesarean delivery. The most common side effect that occurs is hypotension. Some procedures are used to prevent hypotension such as uterine lateral disposition, crystalloid or colloid loading, vasopressor prophylaxis and modified technique of spinal anesthesia. The aim of this research is to compare the effectivity between crystalloid coloading and colloid coloading to prevent hypotension after low dose spinal anesthesia. This research used a single-blind, randomized, controlled, in order to determine the effectiveness of Ringer Laktat (RL) coloading compared Hydroxyethyl Starch (HES) 6% coloading in preventing hypotension after low dose spinal anesthesia in patients undergoing cesarean delivery The study was performed to 50 ASA PS class II patients underwent cesarean delivery with spinal anesthesia was performed using hyperbaric bupivacaine 0,5% 7,5 mg plus fentanyl 25 mcg bupivacai There are no significant difference in demographic data, preanesthesia clinical state (Table 1). Mean Arterial Pressure (MAP) decreased at 2 nd and 4 th minute in both groups where the significant values obtained for the independent t test p <0.05. (Table 2) (Graphic 1) At 2 nd minute, MAP decrease significantly the average 10,1 mmHg (11,5%)in group A and 4,6 mmHg (5,1%) in group B. (Table 2) At 4 th minute, MAP decrease significantly the average 8,5 mmHg (9,7%)in group A and 4,4 mmHg (4,9%) in group B. (Table 2) Incidence of hypotension after spinal anesthesia was found to have hypotension number in both groups. (Table 3) There are no significant difference in demographic data, preanesthesia clinical state (Table 1). Mean Arterial Pressure (MAP) decreased at 2 nd and 4 th minute in both groups where the significant values obtained for the independent t test p <0.05. (Table 2) (Graphic 1) At 2 nd minute, MAP decrease significantly the average 10,1 mmHg (11,5%)in group A and 4,6 mmHg (5,1%) in group B. (Table 2) At 4 th minute, MAP decrease significantly the average 8,5 mmHg (9,7%)in group A and 4,4 mmHg (4,9%) in group B. (Table 2) Incidence of hypotension after spinal anesthesia was found to have hypotension number in both groups. (Table 3) Table 1. The Characteristic of subject Kelompok A ( n =25) was gived RL coloading 1.000 ml Kelompok A ( n =25) was gived RL coloading 1.000 ml Kelompok B ( n =25) was gived HES 6% coloading 500 ml Kelompok B ( n =25) was gived HES 6% coloading 500 ml Blood pressure and heart rate were checked in every 2 minutes after spinal anesthesia until 30 th minute. The data was analyzed using proper statistical analyses, with 95% CI and significancy p<0.05. Table 2. The Dynamics of MAP in both groups Results Graphic 1. MAP changes in both groups Background Methods Hypotension is common during spinal anaesthesia, it develops quickly and leads to adverse effects in both mother and fetus. The basic reasons for its occurrence are rapid blockage of sympathetic nerves and aortocaval compression leading to decreased systemic vascular resistance, decreased venous return because of blood pooling in the periphery, and reduced cardiac output. The decrease in sympathetic efferent activity after spinal anaesthesia is related to the dose of bupivacaine, and intrathecal fentanyl does not lead to further depression in sympathetic efferent activity. In our study, hypotension developed in all subjects in which RL coloading (group A ) and HES 6% coloading (group B) was 16%;4%, respestively but by the chi square test p>0,05, which means no significant difference between the two groups. Similarly, in study by Sonny L that no difference between RL coloading and HES 6% coloading in preventing hypotension after spinal anesthesiai n cesarean delivery Discussion TECHNIQUE SPINAL ANESTHESIA Parameter Group A (n=25) Group B (n=25) p Age (tahun) 1 27,8 ± 4,028,2 ± 4,0 0,309 Body Mass Index(kg/cm 2 ) 1 26,0 ± 1,525,1 ± 1,2 0,273 ASA PS (I/II)0/25 Systolic Blood Pressure (mmHg) 2 119,6 ± 5,1120,9 ± 5,1 0,382 Diastolic Blood Pressure (mmHg) 2 71,5 ± 6,473,1 ± 6,5 0,398 MAP (mmHg) 2 87,8 ± 4,889,1 ± 5,3 0,357 Heart Rate (bpm) 2 77,9 ± 4,975,1 ± 5,9 0,068 1 Shapiro-Wilk test; 2 t-independent test, p<0,05 is significancy Variable Group A (mmHg ± SD) Group B (mmHg ± SD) p* Pre Anesthesia87,8 ± 4,889,1 ± 5,30,357 2 nd Minute77,7 ± 5,984,2 ± 5,8 0,000 4 th Minute79,3 ± 4,384,7 ± 5,6 0,000 6 th Minute81,8 ± 5,585,0 ± 5,90,053 8 th Minute82,8 ± 6,584,8 ± 4,30.187 10 th Minute84,0 ± 6,284,9 ± 4,50,569 12 th Minute83,6 ±5,085,1 ± 6,00,361 14 th Miinute82,5 ± 5,885,2 ± 5,60,195 16 th Minute82,8 ± 7,285,4 ± 3,10,114 18 th Minute82,9 ± 5,185,4 ± 4,00,064 20 th Minute82,8 ± 4,584,8 ± 3,00,064 22 nd Minute82,6 ± 6,285,3 ± 4,80,101 24 th Minute82,8 ± 3,885,0 ± 4,20,053 26 th Minute82,5 ± 4,884,9 ± 3,60,055 28 th Minute82,5 ± 4,384,6 ± 3,10,254 30 th Minute82,9 ± 3,2`84,6 ± 2,90,066 * t-independent test, p<0,05 is significancy Table 3. Incidence of Hypotension. Variable Group A (n = 25) Group B (n = 25) p Yes4 (16%)1 (4%)0,157* No 21 (84%) 24 (96%) Uji Chi-Square, p<0,05 is significancy There is no difference in the effect between coloading RL and coloading HES 6% in preventing hypotension after low dose spinal anesthesia in patients undergoing cesarean delivery. Theory Conclusion Bintartho A, Pryambodho S. Keefektifan anestesi spinal menggunakan bupivakain 0,5% hiperbarik 7,5 mg ditambah fentanyl 25 mcg dibandingkan dengan bupivakain 0,5% hiperbarik 12,5 mg pada bedah sesar. Anesthesia & Critical Care, 28 : 9-17 Brown DL. Spinal, epidural and caudal anesthesia. In : Miller RD editor. Miller’s Anesthesia. 7 th edition. Philadelphia : Churchill Livingstone. 2008 Kang FC, Tsai YC. Subarachnoid fentanyl with diluted small dose bupivacaine for cesarean delivery. Acta Anaesthesiol Scan. 1998:36: 207-14 Nishikawa K. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. Journal of Clinical Monitoring and Computing.2007;21:125-9 Reference VASOPRESSOR FLUID LOADING LOCAL ANESTHETIC SUBJECT SYMPATHETIC BLOCK VASODILATATION HYPOTENSION