COMPARISON OF THE EFFICACY OF CRYSTALLOID PRELOADING AND CO-LOADING FOR PREVENTION OF SPINAL-INDUCED HYPOTENSION IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES AT TERTIARY CARE

Background/Objective: Spinal anesthesia (SA) is popular and well accepted technique for surgeries below umblicus, however, spinal anesthesia induced hypotension (SIH) is a common complication that occurs in 25-75% patients after SA. The timing of intravenous fluid administration plays a significant role in incidence of SIH. Therefore, this study aimed to assess the efficacy of preloading versus coloading in reducing SIH. Methods: A quasi-experimental study was conducted at the Department of Anesthesia, Civil Hospital, Karachi from 26 March 2021 to 26 November 2021. A total of 148 patients in a 1:1 were divided into pre-load (P) and co-load (C) groups. The primary efficacy endpoint was the incidence of SIH in both groups while the secondary efficacy endpoints were the incidence of SIH in both groups based on gender, age, duration of surgery, diabetes status, and smoking status. SPSS software version 26.0 was used for data analysis. Chi-square test was used to check the association among groups. A p-value < 0.05 was considered statistically significant. Results: In the P group, 47.30% patients experienced SIH, while only 27% patients in the C group were affected (p=0.010). 25% patients in the 20-40 years age in the P group developed SIH, whereas none of the patients in the same age range in the C group did. SIH occurred in 59.50% males in group P, compared with patients in group C. None of the 9 smokers in the P group developed SIH, while 17.60% smokers in the C group did. 53.80% in the P group had SIH, compared with 29.80% non- smokers in the C group. These differences were statistically significant (p=0.010) Conclusion: Coloading fluids proved to be beneficial in reducing the incidence of SIH compared to preloading in our study. Future studies with more robust methodologies are needed to establish a more generalizable result.