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RE-EVALUATION OF CRYSTALLOID PRELOAD IN THE PREVENTION OF HYPOTENSION FOLLOWING SUBARACHNOID BLOCK FOR ELECTIVE CAESAREAN SECTION
ABSTRACT
Patients scheduled for elective Caesarean section were studied to determine the minimum
volume of crystalloid infusion preload that would prevent spinal anaesthesia induced
hypotension. A total of 75 patients with uncomplicated, singleton pregnancy and not in labour
booked for elective Caesarean section were recruited in this study. All the patients in this study
were classified as American Society of Anesthesiologists physical status 1-2, and were at term
(37-40 weeks). They were divided into 5 groups with 15 patients in each group according to
the volume of crystalloid preload administered prior to instituting the subarachnoid block (SAB).
Group I patients had no fluid preload, and also served as the control (Standard). The patients
in group 2 (Group II) were preloaded with 5mls/kg of 0.9% normal saline and the third group
(Group III) had 10mls/kg. The fourth (Group IV) and fifth groups (Group V) were administered
15mls/kg and 20mls/kg respectively. Sociodemographic characteristics within the five groups
were closely matched except for the height. Lumbar puncture for the spinal anaesthesia at L3/4
– L4/5 interspace was conducted in the sitting position in all the patients with the aid of pencil
point Whitacre 25G spinal needle. Information on sociodemographic characteristics,
intravenous preloading, total fluid infusion, type and dose of bupivaicaine, neonatal status at
birth, incidence of maternal haemodynamic variables and treatment were documented.
Maternal hypotension was the commonest intra-operative complication with an incidence of
68.0% (n=51). The occurrence of hypotension in group 1 after spinal anaesthesia was as high
as 100% which decreased significantly as the volume of fluid preload increased within the
groups (P ≤ 0.05). Tachycardia and shivering were respectively, the second (50.7%) and third
(44.0%) most common intra-operative complications observed in this study. There were
significant differences within the groups with respect to the volume of 0.9% normal saline
preload, volume of additional fluid given after the subarachnoid block had been established,
duration of hypotension and the dose of ephedrine requirement needed to treat the
hypotension (P ≤ 0.05). The complications were detected early and prompt intervention
instituted accordingly with good outcome.
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