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Author Topic: C-section- what is the appropriate fluid for loading?  (Read 2170 times)

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marivic orellan

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C-section- what is the appropriate fluid for loading?
« on: June 27, 2007, 04:47:52 PM »
hi, everyone!
Im so happy to find this website.
Im presently looking for a topic for my research. Im thinking of investigating the effect of dextrose-containing IVF vs non-D5 containing IVF on the boold sugar level of both the parturient and the fetus. could you help me find related literatures on this topic?

thank you so much for your help. 
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jafo1964

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Re: C-section- what is the appropriate fluid for loading?
« Reply #1 on: June 28, 2007, 12:00:13 AM »
Dextrose containing IV fluids have no role in anaesthesia unless you are dealing with
1. Diabetic patient and Dextrose as part of intra-op regime
2. Proven Hypoglycaemia esp in Neonates

Why is dextrose not used?
1. Anaesthesia perse increases glucose levels even in normal under influence of released stress hormones
2. Anaesthesia leads to decreased quantity and quality of insulin
3. Adverse incidents have poor outcomes in the presence of Hyperglycaemia
4. Intra-op hyperglycaemia produces atleast 8 - 10 undesirable effects on the physiology( any decent literature will give you the details)

What is ideal fluid ?
One that stays in the intravascular compartment longest , is iso-osmotic  and iso- tonic
Crystalloids - RL & NS
Colloids - pick your choice (My choice Hetastarch)

Dextrose containing fluids - owe their osmolality to dextose. Once infused Dex is taken into cell leaving behind hypo-osmotic free water whcih moves intracellular. It does not stay in IV compartment( where youneed it most after SAB) and can produce cellular edema

My recommendation

preload with 20 ml/kg of Rl or NS ( 20% remains in the IV compartment about 20 mins later)
Same dose for colloids produces better and longer lasting effect.
Individual choices for patient or a combination of both carefully weighing the risk- benefit ratio is the best approach

Current ASA advisory on obstetric Anaes Apr 2007

Preloading strongly recommended before CNB.
Does not abolish hypotension but minimizes the severity and duration of hypotension
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manish

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hi to all
« Reply #2 on: July 01, 2007, 04:05:11 PM »
hello, everyone
m really happy to find this site,,and glad to join it.
it's really gonna be very helpful to all of our field and profession..
 
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