Comparison of the effects of hydroxyethyl starch and succinylated gelatin infusion on the perfusion index in elective caesarean sections under spinal anaesthesia

Year 2022, Volume: 5 Issue: 5, 1477 - 1483, 25.09.2022

Erdinç Koca

https://doi.org/10.32322/jhsm.1145979

Abstract

Aim: This study is to compare the alterations of three different replacement fluids on Perfusion Index, Pleth Variability Index (PI, PVI) and hemodynamic data in cases planned to experience caesarean surgery under spinal anaesthesia.
Material and Method: 94 ASAII class patients aged 18–40 that were planned to experience caesarean surgery were included in the study. The patients were divided into three groups according to the fluid replacement to be applied. Patients in Group H received 10 ml/kg of hydroxyethyl starch (HES) up to a maximum of 500 ml over 20 minutes. Patients in Group G got 10 ml/kg of modified liquid gelatin(GEL) up to a maximum of 500 ml over 20 minutes. Patients in Group I got 20 ml/kg of isotonic sodium chloride (0.9% NaCl) over 20 minutes. Routine monitoring and perfusion index, pleth variability index were recorded baseline and at the first, third and tenth min after spinal anaesthesia for all participants
Results: A significant increase in the PI value over time was observed in Groups G and I (p=0.001*). According to the PVI results, the amount of decrease in Group G was statistically less than in the other two groups (p=0.015*).
Conclusion: In conclusion, 0.9% NaCl and gelatine were more effective on PI in caesarean section under spinal anesthesia. Isotonic has a positive effect on both PI and PVI. We detected that PI increased compared to baseline values, and believe that this increase may a positive effect on tissue circulation in the patient.

Keywords

Hydroxyethyl starch, succinylated gelatin, perfusion index

References

• Lee JE, George RB, Habib AS. Spinal-induced hypoten­sion: incidence, mechanisms, prophylaxis, and mana­gement: Summarizing 20 years of research. Best Pract Res Clin Anaesthesiol 2017; 31: 57-68.
• Aya AGM, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg 2003; 97: 867-72.
• Klöhr S, Roth R, Hofmann T, Rossaint R, Heesen M. Definitions of hypotension after spinal anesthesia for caesarean section: Literature search and application to parturients. Acta Anaesthesiol Scand 2010; 54: 909-21.
• Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg 2004; 98: 483-90.
• Hein LG, Albrecht M, Dworschak M, Frey L, Brückner UB. Long-term observation following traumatic-hemorrhagic shock in the dog: a comparison of crystalloidal vs. colloidal fluids. Circ Shock 1988; 26: 353-64.
• Chu H, Wang Y, Sun Y, Wang G. Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis. J Clin Monit Comput 2016; 30: 265-74.
• Aykac ZZ, Arslantas MK. Fluid Therapyand Management (II) Monitoring and Prediction of Fluid Responsiveness. Journal Of Cardio-Vascular-Thoracic Anaesthesia And Intensive Care Society 2018; 24: 1-10.
• Tsuchiya M, Yamada T, Asada A. Pleth variability index predicts hypotension during anesthesia induction. Acta Anaesthesiol Scand 2010; 54: 596–602.
• Hoiseth LO, Hoff IE, Hagen OA, Landsverk SA, Kirkeboen KA. Dynamic variables and fluid responsiveness in patients for aortic stenosis surgery. Acta Anaesthesiol Scand 2014; 58: 826–34.
• Lee HC, Tsai YF, Tsai HI, et al. Pulse oximeter-derived pleth variability index is a reliable indicator of cardiac preload in patients undergoing liver transplantation. Transplant Proc 2016; 48: 1055–8.
• Yokose M, Mihara T, Sugawara Y, Goto T. The predictive ability of non-invasive haemodynamic parameters for hypotension during caesarean section: a prospective observational study. Anaesthesia 2015; 70: 555-62.
• Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth 2014; 23: 324-9.
• Nandini MG, Srinivasaiah M, Jyosthna Prabhat KS, et al. Peripheral perfusion index: a predictor of post-spinal hypotension in caesarean section. Cureus 2022; 14: e25699.
• McKeen DM, George RB, O’Connell CM, et al. Difficult and failed intubation: Incident rates and maternal, obstetrical, and anesthetic predictors. Can J Anaesth 2011; 58: 514-24.
• Kundra P, Khanna S, Habeebullah S, Ravishankar M. Manual displacement of the uterus during Caesarean section. Anesthesia 2007; 62: 460-5.
• Sakai K, Imaizumi T, Maeda H, et al. Venous distensibility during pregnancy. Comparisons between normal pregnancy and preeclampsia. Hypertension 1994; 24: 461–6.
• Adsumelli RS, Steinberg ES, Schabel JE, Saunders TA, Poppers PJ. Sequential compression device with thigh-high sleeves supports mean arterial pressure during Caesarean section under spinal anaesthesia. Br J Anaesth 2003; 91: 695–8.
• Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology 1992; 76: 906-16.
• Wollman SB, Marx GF. Acute hydration for prevention of hypotension of spinal anesthesia in parturients. Anesthesiology 1968; 29: 374-80.
• Park GE, Hauch MA, Curlin F, Datta S, Bader AM. The effects of varying volumes of crystalloid administration before cesarean delivery on maternal hemodynamics and colloid osmotic pressure. Anesth Analg 1996; 83: 299-303
• Mathru M, Rao TL, Kartha RK, Shanmugham M, Jacobs HK. Intravenous albumin administration for prevention of spinal hypotension during cesarean section. Anesth Analg 1980; 59: 655-8.
• MacLennan FM, MacDonald AF, Campbell DM. Lung water during the puerperium. Anaesthesia 1987; 42: 141-7.
• Baraka AS, Taha SK, Ghabach MB, Sibaii AA, Nader AM. Intravascular administration of polymerized gelatin versus isotonic saline for prevention of spinal-induced hypotension. Anesth Analg 1994; 78: 301-5.
• Ehrly AM, Seebens H, Saeger-Lorenz K. Effect of a 10% and 6% hydroxyethyl starch solution (molecular weight 200,000/0.62) in comparison with a 10% dextran solution (molecular weight 40,000) on flow properties of blood and tissue oxygen pressure in patients with intermittent claudication. Infusionstherapie 1988; 15: 181-7.
• Lobo DN, Stanga Z, Aloysius MM, et al. Effect of volume loading with 1 liter intravenous infusions of 0.9% saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume and endocrine responses: a randomized, three-way crossover study in healthy volunteers. Crit Care Med 2010; 38: 464-70.
• Kukkonen SI, Niemi TT. Comparison of the effect of 6% hydroxyethyl starch and gelatine on cardiac and stroke volume index: a randomized, controlled trial after cardiac surgery. Perfusion 2010; 25: 283–91.
• Rittoo D, Gosling P, Bonnici C, et al. Splanchnic oxygenation in patients undergoing abdominal aortic aneurysm repair and volume expansion with eloHAES. Cardiovasc Surg 2002; 10: 128-33.
• Gine`s A, Ferna´ndez-Esparrach G, Monescillo A, et al. Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 1996; 111: 1002-10.
• Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg 2009; 108: 549–53.
• Cannesson M, Delannoy B, Morand A, et al. Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg 2008; 1061: 189–94.
• Sadat-Safavi SA, Nasiri S, Shojaiefard A, et al. Comparison the effect of stump closure by endoclips versus endoloop on the duration of surgery and complications in patients under laparoscopic appendectomy: A randomized clinical trial. J ResMedSci 2016; 21: 87.
• Feldman JM, Sussman E, Singh D Friedman BJ. Is the pleth variability index a surrogate for pulse pressure variation in a pediatric population under going spine fusion? Paediatr Anaesth, 2012; 22: 250-55.
• Coeckelenbergh S, Delaporte A, Ghoundiwal D, et al. Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low to-moderate risk abdominal surgery: a randomized controlled trial. BMC Anesthesiology 2019; 19: 34.
• Kumar A, Nadkarni AV. The variability of perfusion index as a new parameter in different types of anaesthesia techniques and its correlation with surgical stress and recovery from anesthesia: an observational clinical study. J Med Sci Clin Res 2017; 5: 15196–265.