The hemodynamic effects of hypertonic saline preload versus co-load measured by non-invasive cardiometry in patients undergoing TURP surgery: a randomized controlled trial
Abstract
Background & objective: Transurethral resection of prostate (TURP) is usually performed under spinal anesthesia. To control spinal hypotension intravenous fluids are infused. We evaluated the effect of timing of hypertonic saline infusion as a preload or a co-load on hemodynamic parameters in patients undergoing TURP using non-invasive cardiometry.
Methodology: A randomized controlled study was conducted. A total of 100 ASA physical status I-III patients planned for TURP under subarachnoid block were randomly assigned to either a preload of 4 ml/kg of hypertonic saline (NaCl 3%) over 15-20 min before spinal anesthesia (Group P, n = 50) or a co-load at the maximum rate at the moment of cerebrospinal fluid identification (Group C, n = 50). Cardiometry was used to measure cardiac output and systemic vascular resistance; and mean arterial blood pressure, systolic blood pressure, heart rate, and the requirement for ephedrine and serum sodium levels were recorded.
Results: There was a rise in cardiac output readings at 5, 10 and 15 min in both groups, but Group P showed a significantly more rise compared to Group C after spinal anesthesia and compared with their baseline values. As for the systemic vascular resistance, a substantial drop occurred in Group P at 5, 10, and 15 min when compared to Group C, as well as when compared to their baseline levels. Except for considerably lower systolic blood pressure readings at 5 min after spinal block in Group P, in both groups, systolic blood pressure and heart rate changes were comparable. The median dose of ephedrine required for Group P patients was significantly greater.
Conclusion: Hypertonic saline co-loading is more effective than its preloading in decreasing hypotension occurring with subarachnoid anesthesia for TURP surgery.
Abbreviations: CO: Cardiac Output; HR: Heart Rate; SBP: Systolic Blood Pressure; SD: Standard Deviation; SV: Stroke Volume; SVR: Systemic Vascular Resistance; TURP: Transurethral Resection of the Prostate.
Key words: Hypertonic Saline; Co-load; Preload; Cardiometry; Subarachnoid Anesthesia; TURP
Citations: Seif NE, El-Kholy MM, El-Gohary MM, Wahba SAA, Jaccoub VF. The hemodynamic effects of hypertonic saline preload versus co-load measured by non-invasive cardiometry in patients undergoing TURP surgery: a randomized controlled trial. Anaesth. pain intensive care 2024;28(2):227−236.
Received: May 02, 2023; Revised: December 12, 2023; Accepted: February 27, 2024
