Prophylaxis for hypotension during cesarean section under spinal anesthesia: a randomized trial comparing hydroxyethyl starch 130/0.4 to ephedrine

• Published in: Revista española de anestesiología y reanimación Vol. 58; no. 1; p. 17
• Main Authors: Osseyran Samper, F, Errando, C L, Plaza Lloret, M, Díaz Cambronero, O, García Gregorio, N, de Andrés Ibáñez, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-01-2011
• Subjects: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; Cesarean Section; Ephedrine - therapeutic use; Female; Humans; Hydroxyethyl Starch Derivatives - administration & dosage; Hypotension - prevention & control; Intraoperative Complications - prevention & control; Plasma Substitutes - administration & dosage; Pregnancy; Prospective Studies; Single-Blind Method; Vasoconstrictor Agents - therapeutic use
• ISSN: 0034-9356
• DOI: 10.1016/S0034-9356(11)70693-4

Spinal anesthesia is the technique of choice for scheduled or emergency cesarean section, but the prevalence of hypotension is high in this setting. Our aim was to compare the efficacy of a colloid (6% hydroxyethyl starch [HES] 130/0.4) to ephedrine for preventing hypotension.
Patients undergoing elective or emergency cesarean section (in non-life-threatening situations) were enrolled. Patients were randomized to 3 groups for prophylaxis. The first ephedrine group received 5 mg of ephedrine intravenously (EPHE-5); the second ephedrine group received 10 mg of the drug intravenously (EPHE-10); and the HES group received 500 mL of HES 130/0.4 in rapid infusion n 15 minutes. We recorded systolic and diastolic blood pressures and heart rate after 10 minutes in the operating room and 2, 5, 10, 15, 20, and 30 minutes after injection of the anesthetic. We also assessed the sensory and motor blockades on both sides 2, 5, 10, 15, 20, and 30 minutes after injection. Neonatal status was assessed by Apgar score and umbilical cord blood gas analysis.
Ninety-six patients, 33 in each ephedrine group and 30 in the HES group, were enrolled. Blood pressure decreased similarly in all 3 groups (36% EPHE-5 group, 36% EPHE-10 group and 40% HES group); no significant between-group differences were observed. Nor were there significant differences in the percentages of patients requiring bolus doses of ephedrine to treat hypotension (23% in the HES group vs 33% in the EPHE-5 group and 27% in the EPHE-10 group) or in the cumulative doses of ephedrine. Neonatal status was also similarly satisfactory in all 3 groups.
HES 130/0.4 is as useful for hypotension prophylaxis as 5-mg or 10-mg intravenous doses of ephedrine. HES 130/0.4 might be a substitute for sympathomimetic agents if adverse effects are predicted or contraindications to the use of such drugs are present.