الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 103 |  |  |
| | | from | 103 | | |
Abstract
Maternal hypotension is the commonest serious problem following spinal anaesthesia for Caesarean section, with an incidence up to 83%.
Traditionally, IV crystalloid fluids are administered in the (20 min) before the induction of spinal anesthesia for cesarean delivery (preload) which may reduce but not eliminate hypotension. A more rational approach is to administer the fluid bolus at the time that the local anesthetic block is starting to take effect. This might maximize intravascular volume expansion during vasodilatation from the sympathetic blockade and limit fluid redistribution and excretion. This practice has been termed ”coload”.
The present study was designed to compare between colloid and crystalloid co-load with spinal anesthesia during emergent cesarean section and their effect on hemodynamic changes. It was carried out on 75 females presented for emergent CS at menofia University Hospital. Those females were randomly allocated to one of three equal groups; the first group (crystalloid group), in which females were co-loaded with 15ml/kg lactate ringer solution; group B (Colloid group), in which females were co-loaded with 5ml/kg voluven solution and group C (combined group), in which females were co-loaded with both crystalloid and colloid solution (7.5ml/kg LR solution with 2.5ml/kg voluven solution).
Hemodyanmic measurements were obtained just before induction of spinal anesthesia (basal values) and then every 5 minutes after co-loading, till 60 minutes. Episodes of hypotension, vasopressors and side effects such as nausea and vomiting were recorded.
The present study revealed that, there was no significant differences between studied groups as regards age, weight, basal blood pressure measurement, basal heart rate and basal oxygen saturation.
Also, there was no significant difference between studied groups as regards systolic blood pressure at basal, 5, 10, 20, 25, 30 and 35 minutes, while there was significant decrease of SBP at 15 minutes at group A (103.60±21.59) in comparison to either group B (111.48±17.32) or group C (115.52±10.01).
Again, there was no significant difference between studied groups as regard diastolic blood pressure at basal values, 5, 10, 25, 30, 40, 50 and 60 minutes, while there was significant decrease of DBP in group A in comparison to either group B or C at 15 and 20 minutes. Similar findings were reported for mean arterial pressure.
There was no significant difference between studied groups as regards heart rate or oxygen saturation at any time.
First episode of hypotension was reported in 48%, 20.0% and 8% in groups A, B and C respectively with significant difference between studied groups. In group A, first episode started to occur at 10 minutes and maximally occurred at 15 minutes, while in group B, it starts to occur at 5 minutes and maximally occurred at 15 minutes and finally in group C it occurred equally at 20 and 30 minutes There was significant difference between studied groups as first bolus of vasopressors. The total number of boluses was significantly increased in group A and B in comparison to group C.
Nausea and vomiting occurred in 14 cases (18.7%) and there was significant increase in group A (40.0%) in comparison to group B (12.0%) and group C (4.0%).
Finally, there was no significant difference between studied groups as regards apgar score.