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      The Effects of Pre-Spinal Anesthesia Administration of Crystalloid and Colloid Solutions on Hypotension in Elective Cesarean Section

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          Abstract

          Background

          Spinal anesthesia is an appropriate alternative for general anesthesia in many operations, particularly in cesarean section. However, the induced hypotension is the main drawback of this method. Therefore, the current study aimed at comparing the effects of crystalloid and colloid solutions used as the preload on the post-spinal hypotension and its complications in females who are candidate for elective cesarean section.

          Methods

          The current randomized, controlled, double-blind study was conducted on the female candidate of elective cesarean section (n = 96; age range: 20 to 40 years). The patients were in their 37 to 42 weeks of gestational age during the experiments. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) variation, amount of injected ephedrine during surgery, Apgar score at birth, total solution infused after spinal anesthesia, urine output, nausea, and vomiting were comparatively assessed between the two groups.

          Results

          The percentages of reduction in SBP and DBP variables in the crystalloid solution were higher than those of the colloid group and the differences were statistically significant (P = 0.042 and P = 0.008, respectively). Average percentage of HR changes was more significant in the crystalloid than the colloid group (P = 0.032). In contrary, administration of the two types of solutions did not result in significant differences in the Apgar scores. The prevalence of nausea and vomiting in the colloid group subjects was lower than those of the crystalloid solution group; however, the differences were not significant.

          Conclusions

          The current study findings recommend colloid solution to prevent hemodynamic instability after spinal anesthesia. However, the costs and availability of the solution and recommendation of anesthesiologist should be considered. Conduction of further clinical trials with larger sample sizes is recommended.

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          Most cited references19

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          Postoperative pain management

          Farnad Imani (2011)
          The practice of modern anesthesiology has been developed from intraoperative period into perioperative period. Postoperative pain management is one of the most important components of adequate post-surgical patients care. This article wrote with the aim of emphasis on importance and effectiveness of post-operative pain management. Reading this article is beneficial for physicians, interventional pain managers and who care about pain medicine. Unrelieved acute pain after surgery usually elicits pathophysiologic neural alterations, including not only peripheral but also central sensitization which evolves into chronic pain syndromes. The main purpose of perioperative pain control is providing an adequate comfort level and acceptable side effects for patients. Effective postoperative analgesia improves patients’ outcome as observed by early ambulation, decrease in side effects, and reduce the incidence of postoperative chronic pain (1-3) Even though postoperative pain management and its implications have gained a significant attention in health care during last three decades, it continues to be a major challenge that still remains disregarded (4, 5). Postoperative analgesia has traditionally been provided by administration of opioid analgesics. However, excessive opioids administration is associated with a variety of side effects including ventilatory depression, drowsiness and sedation, nausea and vomiting, pruritus, ileus, urinary retention, and constipation. Prescription of multi-modal analgesic regimens contains non-opioid analgesics (e.g., local anesthetics, nonsteroidal anti-inflammatory drugs, cyclooxygenase inhibitors, acetaminophen, ketamine, clonidine, dexmedetomodine, gabapentin) as supplement of opioid analgesics can provide better postoperative pain management outcome. The opioid-sparing effects of these compounds may lead to reduced side effects of opioids (6). Nowadays variety of new drugs, analgesic techniques and devices, and preventive approaches are available for anesthesiologists, including patient-controlled analgesia (PCA), multimodal analgesia and pre-emptive analgesia. Besides, one of the most common methods for postoperative pain relief is PCA. This device is commonly assumed to imply on-demand intermittent, intravenous administration of opioids under patient control (with or without a continuous background infusion). PCA device is based on the use of a sophisticated microprocessor-controlled infusion pump that delivers a preprogrammed dosage of opioid analgesics when the patient pushes a demand button. Grass presented a more enlightened concept of PCA, noting that using any analgesic drugs under control of patient by any routes could be categorized as PCA, like patient-controlled epidural analgesia (PCEA) and patient-controlled regional analgesia (PCRA) (7). He proposed practical guidelines for the clinical usage of PCA, highlighted the complications and their management. To optimize the management of acute postoperative pain, basic mechanisms of postoperative pain must be explored and new treatments must continue to be developed. Tissue damages during surgery leads to two alterations in the responsiveness of the nociceptive system, peripheral sensitization and central sensitization. Pharmacological and non-pharmacological postoperative pain management should be started quickly to suppress the development of both peripheral and central sensitization, which involves both the primary afferent nociceptors and spinal dorsal horn neurons. Understanding the neuropharmacology of the spinal cord gives us the unbelievable opportunity to base clinical management on identified mechanisms of pain receptors, pathways, and mechanisms of action. Furthermore, evidence-based practice guidelines have the potential to provide valuable information to physicians and their patients. These guidelines not only provide guidance in routine practice, but they provide the “standard of care” for the specialists. Practice guidelines for anesthesiology and pain medicine must be improved by experts in these fields using the best available data obtained from a comprehensive review of the peer-reviewed medical literature.Anesthesiology and Pain Medicine, the official journal of Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM), aims at publishing of the scientific articles submitted by all the researchers and professionals in the field of anesthesiology and pain medicine from all over the world. It would be our pleasure to take our new steps toward medical excellence.
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            General compared with spinal anesthesia for total hip arthroplasty.

            Bryce Basques, Jason Toy, Daniel Bohl … (2015)
            Total hip arthroplasty may be performed under general or spinal anesthesia. The purpose of the current study was to compare perioperative outcomes between anesthetic types for patients undergoing primary elective total hip arthroplasty.
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              Patient preferences for anesthesia outcomes associated with cesarean delivery.

              Alex Macario, Brendan Carvalho, Paula Cohen … (2005)
              When deciding on neuraxial medication (e.g., spinal opioids) for cesarean delivery (CS) under regional anesthesia, anesthesiologists make treatment decisions that "trade off" relieving pain with the potential for increased risk of side effects. No previous studies have examined obstetric patients' anesthesia preferences. Researchers administered 100 written surveys to pregnant women attending our institutions' expectant parent class. We determined patients' preferences for importance of specific intraoperative and postoperative anesthesia outcomes using priority ranking and relative value scales. We also explored patients' fears, concerns, and tolerance regarding CS and analgesics. Eighty-two of 100 surveys were returned and analyzed. Pain during and after CS was the greatest concern followed by vomiting, nausea, cramping, pruritus, and shivering. Ranking and relative value scores were closely correlated (R2 = 0.7). Patients would tolerate a visual analog pain score (0-100 mm) of 56 +/- 22 before exposing their baby to the potential effects of analgesics they receive. In contrast to previous general surgical population surveys that found nausea and vomiting as primary concerns, we found pain during and after CS as parturients' most important concern. Common side effects such as pruritus and shivering caused only moderate concern. This information should be used to guide anesthetic choices, e.g., inclusion of spinal opioids given in adequate doses. Medical care can be improved by incorporating patients' preferences into medical decision making. We surveyed obstetric patients to determine their preferences regarding potential cesarean delivery anesthesia outcomes. Unlike general surgical patients who rate nausea and vomiting highest, parturients considered pain during and after cesarean delivery the most important concern.
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                Author and article information

                Contributors
                Mohammad Reza Gousheh
                Reza Akhondzade
                Hamid Asl Aghahoseini
                Alireza Olapour
                Mahbobe Rashidi
                Journal
                Journal ID (nlm-ta): Anesth Pain Med
                Journal ID (iso-abbrev): Anesth Pain Med
                Journal ID (doi): 10.5812/aapm
                Journal ID (publisher-id): Kowsar
                Title: Anesthesiology and Pain Medicine
                Publisher: Kowsar
                ISSN (Print): 2228-7523
                ISSN (Electronic): 2228-7531
                Publication date (Electronic): 08 August 2018
                Publication date Collection: August 2018
                Volume: 8
                Issue: 4
                Electronic Location Identifier: e69446
                Affiliations
                [1 ]Department of Anesthesiology, Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Irann
                Author notes
                [* ]Corresponding Author: Department of Anesthesiology, Pain Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Azadegan Ave., Ahvaz, Iran. Tel: +98-6132220168, Email: rezaakh@ 123456hotmail.com
                Article
                DOI: 10.5812/aapm.69446
                PMC ID: 6139530
                PubMed ID: 30250818
                SO-VID: 0623f831-68af-4022-9aad-73a85a61139f
                Copyright © Copyright © 2018, Author(s)
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

                History
                Date received : 15 April 2018
                Date revision received : 22 July 2018
                Date accepted : 23 July 2018
                Categories
                Subject: Research Article

                Keywords: hypotension,colloid solution,crystalloid solution,spinal anesthesia,cesarean section
                Data availability:
                Keywords: hypotension, colloid solution, crystalloid solution, spinal anesthesia, cesarean section

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