Incident of hypotension after performing spinal anesthesia during preloading of fluid gelatin and phenylephrine during spinal anesthesia compared with those with only fluid gelatin in patients undergoing cesarean section
Keywords:
hypotension, spinal anesthesia, cesarean section, fluid gelatin, phenylephrineAbstract
Introduction: Spinal anesthesia is recommended for those undergoing a cesarean section. As a result, the sympathetic autonomic nervous system is suppressed. The hypotension is a major side effect, which may result in a bradycardia or death in severe cases.
Objectives: To compare hypotension after spinal anesthesia during preloading (given before spinal anesthesia) between the administration of fluid gelatin and intravenous phenylephrine during spinal anesthesia and the administration of fluid gelatin only in patients undergoing cesarean section.
Methods: The study was conducted on the basis of randomized comparative trial, therapy (intervention) in female patients aged 18-44 years, 37-40 weeks gestational age, during 2020-2021 at Chaiyaphum hospital, Chaiyaphum province, Thailand. The index group consisted of patients given 500 mL of fluid gelatin preloading and intravenous 100 mcg phenylephrine during spinal anesthesia (GP). The comparison group consisted of patients given 500 ml of fluid gelatin preloading (G). Study size estimation is 42 cases per group.
Results: Each group consisted of 42 patients. The baseline data for both groups of patient and infants were not different. The mean age was 29 years, gestational age 38 weeks, weight 66 kg, BMI 26 kg/m2. However, data during the intraoperative period showed that the GP group had less intraoperative blood loss than the G group (310.7±100.9 and 366.7±124.3, p=0.093) and had a high level of anesthesia (above level T4) greater than the G group (57.0% and 33.3%, p=0.048). The GP group had less hypotension than the G group, but this was not statistically significant (40.5% and 57.1%, p=0.190). When different factors such as blood loss and a high level of anesthesia, were adjusted difference by risk difference regression, it was found that patients in the GP group had hypotension less than the G group 21.06% with statistical significance. If a preventive method is used by giving GP to 5 patients, hypotension shall be reduced in 1 patient (NNT=5) and there were no significant differences of side effects in patients and infants.
Conclusion: The administration of 500 mL of fluid gelatin preloading with 100 mcg of phenylephrine given during spinal anesthesia undergoing cesarean section contribute to a lower incident of hypotension than the administration of a single fluid gelatin. Therefore, it may be considered to be given in good health patients who have undergone a cesarean section and not contraindicated with these drugs.
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