A comparison of HES 6% 130/0.42 versus HES 6% 130/0.4 before spinal anaesthesia in Caesarean section patients : the effects on haemodynamics, haemoglobin, liver tests and thromboelastometry
Faculty of Medicine and Health Sciences
Jurnalul Român de Anestezie Terapie Intensivă
, p. 21-27
University of Antwerp
Background. Prehydration before C-section is a controversial issue. As it was demonstrated in several studies starches may be better than crystalloids in increasing circulating volume and cardiac output. In the present study we wanted to evaluate the efficacy of two tetrastarch solutions on the incidence and severity of hypotension following a combined spinal-epidural anaesthesia (CSE) for elective C-section. Method. Of the 60 patients enrolled, 29 and 28 patients terminated the study in the HES 130/0.42/6:1 (Venofundin® or Venohes®, Ve group) and HES 130/0.4/9:1 (Voluven®, Vo group) respectively. Both groups received 500 mL of the solution and 1000 mL of Ringers Lactate before the spinal injection as part of a CSE technique. We compared the haemodynamic parameters between the two solutions and their effect upon thromboelastometry, haemoglobin level and liver/kidney function tests. Results. There were no differences with respect to haemodynamic parameters such as lowest blood pressure values or vasopressor use. The only difference found, regardless of the group allocation, was a significantly higher lowest systolic blood pressure in parturients receiving the spinal injection in the sitting position or those undergoing their delivery during the morning hours. Thromboelastometry and LDH concentration was affected more significantly following Voluven® use but there were no significant differences between both solutions. Haemoglobin level decreased more significantly in the Vo group while not in the Ve group. The difference between both colloids was significant as well. Alkaline phosphatase, γGT and bilirubin decreased to the same extent with both colloids. Conclusion. There were no differences with respect to haemodynamics between the two colloids but that Voluven® had more effect on the thromboelastometry pattern and LDH while for the decrease of the haemoglobin concentration the difference was significant as compared to Venofundin®/Venohes®. Although significant changes were measured, the values remained within the normal reference range while it is unclear whether the extent of alterations was above and beyond the effect of haemodilution.