Comparative effect of 6% hydroxyethyl starch (containing 1% dextrose) and lactated Ringer's solution for cesarean section under spinal anesthesia

Purpose. This study aimed to compare low-molecular weight hydroxyethyl starch containing 1% dextrose (HES) infusion and lactated Ringer's solution (LR) in the prevention of hypotension associated with spinal anesthesia for cesarean section. Methods. Sixty-seven patients scheduled for cesarean section under spinal anesthesia were randomly allocated to receive either LR (n = 35) or HES (n = 32) infusion before cesarean delivery. Infusion of the fluid was started immediately after arrival at the operating room, through two fully open i.v. routes of 18 or 16 gauge. The two groups were compared in terms of the incidence of hypotension; ephedrine dose; cord and maternal blood gas, hemoglobin, and glucose; and Apgar scores. Results. Intravenous fluid volume until delivery in the LR group was significantly greater than that in the HES group (1298 ± 503 and 973 ± 339 ml, respectively) in spite of the similar periods of intravenous infusion (18.1 ± 3.9 and 18.2 ± 4.1 min). The incidence of hypotension, and the ephedrine dose, blood gas analyses, and Apgar scores were not significantly different between the groups. The ephedrine dose correlated with the anesthesia level by spinal anesthesia (P < 0.05). Conclusion. This study did not show an advantage of HES compared with LR in the prevention of hypotension or in the reduction of ephedrine dose during cesarean section under spinal anesthesia. The anesthesia level, rather than the choice of intravenous fluid solution, might be related to the ephedrine dose.