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Bolus injection of Ringer's solution and dextran 1 kDa during induction of spinal anesthesia

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Arterial hypotension following induction of spinal anesthesia is difficult to prevent with infusion fluids. In a randomized, unblinded and controlled study we evaluated whether a rapid fluid administration planned according to volume kinetic analysis is followed by a more stable blood pressure. Methods: 

Spinal anesthesia was induced in 75 surgical patients, using one of three different fluid regimens: intravenous ‘bolus injection’ of 5 ml kg−1 of Ringer's acetate over 3 min, 2 ml kg−1 of low-molecular weight (1 kDa) dextran over 3 min, or a constant-rate infusion of 15 ml kg−1 of Ringer's acetate over 40 min (controls). The kinetics of the fluid was studied in five patients in each group and also in eight volunteers. Results: 

The decrease in mean arterial pressure averaged 28%, 27% and 26%, respectively, and was fully developed 16 min after the induction. The height of the block, but not the fluid programme, correlated with the hypotension. Nausea or near-fainting associated with marked hypotension or bradycardia was recorded in none, five (20%) and two (8%) of the patients, respectively. Both bolus injections were followed by translocation of fluid from the peripheral tissues to the bloodstream, which maintained the plasma dilution at about 10% for at least 30 min until surgery began. Conclusion: 

A brisk infusion of Ringer's solution or dextran 1 kDa over 3 min was followed by the same decrease in arterial pressure as a longer and 3–5-times larger infusion of Ringer's solution over 40 min during induction of spinal anesthesia.
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Keywords: Dextran; fluids; hemodilution; i.v; pharmacokinetics; spinal anesthesia

Document Type: Research Article

Affiliations: 1: South Hospital, and 2: Karolinska Institute, Stockholm, Sweden

Publication date: 2005-02-01

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