Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000600005
Brazilian Journal of Anesthesiology
Scientific Article

Expansão volêmica em raquianestesia para cesariana: comparação entre cristalóide ou colóide

Preload during spinal anesthesia for cesarean section: comparison between crystalloid and colloid solutions

Mônica Maria Siaulys Capel Cardoso; Sandra Bliacheriene; Cláudia R C Freitas; Daniel S César; Marcelo Luís Abramides Torres

http://dx.doi.org/10.1590/S0034-70942004000600005 Braz J Anesthesiol, vol.54, n6, p.781-787, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: A hipotensão arterial materna é a complicação mais comum após raquianestesia para cesariana. O objetivo deste estudo foi comparar o bem estar materno e fetal de pacientes submetidas à cesariana sob raquianestesia, após expansão volêmica com cristalóide ou colóide (gelatina fluida modificada). MÉTODO: Foram estudadas prospectivamente 50 gestantes de termo, estado físico ASA I, submetidas à cesariana sob raquianestesia. As pacientes foram aleatoriamente divididas em dois grupos que receberam expansão volêmica como segue: Grupo Cristalóide 10 ml.kg-1 de Ringer com lactato e Grupo Colóide, 10 ml.kg-1 de solução coloidal (gelatina fluida modificada). Definiu-se como pressão arterial de controle a média de três valores sucessivos de pressão arterial sistólica (PAS). A PAS foi medida a cada minuto e administrou-se bolus de 0,2 mg de metaraminol, por via venosa, para diminuição de PAS maior que 10% e bolus de 0,4 mg para diminuição de PAS maior que 20%. Ao nascimento avaliou-se o índice de Apgar e realizou-se gasometria da artéria umbilical. A análise estatística foi feita com os testes t de Student modificado e para igualdade de variáveis (p < 0,05). RESULTADOS: A hipotensão arterial 10% (100% e 100% das pacientes); hipotensão arterial 20% (72% e 72% das pacientes), náusea (4% e 8% das pacientes); consumo de vasopressor (1,67 ± 0,89 mg e 1,88 ± 0,74 mg) e pH da artéria umbilical (7,25 ± 0,04 e 7,26 ± 0,04), nos grupos Cristalóide e Colóide, respectivamente foram semelhantes. CONCLUSÕES: Nas condições estudadas, o colóide (gelatina fluida modificada) se mostrou equivalente ao cristalóide (Ringer com lactato) no sentido de garantir o bem estar materno e fetal.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, VOLEMIA, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: Maternal hypotension is the most common complication following spinal anesthesia for cesarean section. This study aimed at comparing the incidence of hypotension and the need for vasopressors in patients submitted to cesarean section under spinal anesthesia following preload with either crystalloid or colloid (modified fluid gelatin). METHODS: Participated in this prospective study 50 term pregnant patients, physical status ASA I, submitted to cesarean section under spinal anesthesia. Patients were randomly allocated into two groups receiving preload as follows: Crystalloid group, 10 mL.kg-1 lactated Ringer; Colloid group, 10 mL.kg-1 colloid (modified fluid gelatin). Control blood pressure was defined as the mean of three successive systolic blood pressure (SBP) values. SBP was measured at 1-minute intervals and 0.2 mg intravenous bolus of metaraminol was administered for SBP decrease above 10% of control blood pressure, and 0.4 mg bolus of the same drug for SBP decrease above 20% of control. Apgar score was evaluated after delivery and umbilical artery blood was sent for analysis. Modified Student's t test was used for statistical analysis and p < 0.05 was considered statistically significant. RESULTS: Hypotension 10% (100% and 100% of patients); hypotension 20% (72% and 72% of patients), nausea (4% and 8% of patients); vasopressor consumption (1.67± 0.89 mg and 1.88 ± 0.74 mg) and umbilical artery pH (7.25 ± 0.04 and 7.26 ± 0.04), in Crystalloid and Colloid groups, respectively, were similar. CONCLUSIONS: In the conditions of this study, colloid (modified fluid gelatin) was equivalent to crystalloid (lactate Ringer) in preventing or decreasing the incidence of hypotension in patients submitted to cesarean section under spinal anesthesia

Keywords

COMPLICATIONS, SURGERY, SURGERY, VOLEMY, VOLEMY

Referencias

Rout C, Rocke DA. Spinal hypotension associated with Cesarean section: will preload ever work?. Anesthesiology. 1999;91:1565-1567.

Ewaldsson CA, Hahn RG. Volume kinetics of Ringer's solution during induction of spinal and general anaesthesia. Br J Anaesth. 2001;87:406-414.

Cardoso MMSC, Santos MM, Yamaguchi ET. Expansão volêmica em raquianestesia para cesariana. Como realizá-la?. Rev Bras Anestesiol. 2004;54:13-19..

Morgan PJ, Halpern SH, Tarshis J. The effects of an increase of central blood volume before spinal anesthesia for cesarean delivery: a qualitative systematic review. Anesth Analg. 2001;92:997-1005.

Ueyama H, He YL, Tanigami H. Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section. Anesthesiology. 1999;91:1571-1576.

Riley ET, Cohen S, Rubenstein AJ. Prevention of hypotension after spinal anesthesia for cesarean section: six percent hetastarch versus lactated Ringer's solution. Anesth Analg. 1995;81:838-842.

Vercauteren MP, Hoffmann V, Coppejans HC. Hydroxyethylstarch compared with modified gelatin as volume preload before spinal anesthesia for Cesarean section. Br J Anaesth. 1996;76:731-733.

Carvalho JCA, Mathias RS, Senra WG. Maternal, fetal and neonatal consequences of acute hydration during epidural anesthesia for c-section. Reg Anesth. 1993;18(2S):19.

Birnbach D, Gatt S, Datta S. Textbook of Obstetric Anesthesia. Allergic Reactions. 2000:475-476.

Ngan Kee WD, Khaw KS, Lee BB. Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section. Br J Anaesth. 2001;87:772-774.

Oliveira SDS, Yamaguchi ET, Goulart TF. Vasopressores em raquianestesia para cesariana. Efedrina versus metaraminol. Rev Bras Anestesiol. 2003;53(^s31).

Ngan Kee WD, Khaw KS, Lee BB. Metaraminol infusion for maintenance of arterial blood pressure during spinal anesthesia for cesarean section: the effect of cristalloid bolus. Anesth Analg. 2001;93:703-708.

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