Crystalloids versus colloids versus hypertonic saline co-load during spinal anesthesia: Which is more effective?

Abstract

Background: Spinal anesthesia is very commonly accompanied by hypotension due to sympathetic blockade, which leads to vasodilation. There is an ongoing debate concerning pre-load versus co-load and also the best suitable type of fluid to be given, including hypertonic saline (HS). We conducted this study to compare the efficacy of the three solutions, crystalloids vs. colloids vs. hypertonic saline co-load during spinal anesthesia. Methodology: 120 adult patients were randomly allocated into one of the three groups, each consisting of 40 patients; Group A: Received crystalloids (normal saline 0.9% 15 ml/kg), Group B: Received colloids (hydroxyethyl starch 130/0.4 in 0.9 % sodium chloride 5 ml/kg) and Group C: Received hypertonic saline 3% (3 ml/kg). Serum sodium level, osmolarity, number and doses of ephedrine required, mean arterial pressure (MAP), stroke volume (SV), systemic vascular resistance index (SVRI) and cardiac index (CI) were measured. Results: MAP, SVRI, CI and SV values were comparable throughout the study time in all the three groups. The need for ephedrine and total doses were statistically significant for the Group B (p < HS group) (p = 0.02 and < 0.005 respectively). The changes in serum sodium and osmolarity were significant (p = 0.005) but remaining within the normal levels. Conclusion: The use of hypertonic saline as a co-loading fluid may maintain hemodynamics after spinal anesthesia without the need of infusing large fluid volume making it a good alternative for the use in fluid restricted patients.