Vol. 7, Issue 1, Part A (2025)

Introduction: Hypotension following spinal anesthesia is a common complication in cesarean sections, which can compromise maternal and fetal outcomes. Various preventive strategies such as fluid preloading, vasopressor use, and left uterine displacement have been studied. This study compares the efficacy of 6% hydroxyethyl starch (HES), phenylephrine, and Ringer’s lactate in preventing hypotension during spinal anesthesia.

Methods: A randomized, double-blind, controlled study was conducted at Department of Anaesthesia, GMERS Medical College and General Hospital, Gandhinagar involving 120 ASA I and II parturients undergoing elective cesarean section under spinal anesthesia. Participants were randomized into three groups: Group A (Ringer’s lactate preload + HES Coload), Group B (Ringer’s lactate Coload + phenylephrine bolus), and Group C (Ringer’s lactate preload alone). Hemodynamic parameters, incidence of hypotension, vasopressor requirements, and adverse effects were analyzed.

Results: Baseline demographic characteristics were similar across groups (p>0.05). The incidence of hypotension was significantly lower in Groups A (10%) and B (12%) compared to Group C (35%) (p<0.001). Mean arterial pressure (MAP) was better maintained in Group B (82.3±7.4 mmHg) compared to Groups A (79.1±8.1 mmHg) and C (73.4±9.0 mmHg). Rescue vasopressor requirement was significantly higher in Group C (mean dose: 55.2±7.3 μg) compared to Groups A (30.5±6.1 μg) and B (22.1±5.9 μg) (p<0.01).

Conclusion: Phenylephrine and hydroxyethyl starch significantly reduce the incidence of post-spinal hypotension compared to Ringer’s lactate alone. Phenylephrine was the most effective in maintaining MAP and reducing rescue vasopressor needs.