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Randomized Controlled Trial
. 2014 May 16:14:36.
doi: 10.1186/1471-2253-14-36. eCollection 2014.

Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload

Ah-Young Oh  1 , Jung-Won Hwang  1 , In-Ae Song  2 , Mi-Hyun Kim  3 , Jung-Hee Ryu  1 , Hee-Pyoung Park  4 , Yeong-Tae Jeon  1 , Sang-Hwan Do  1
Affiliations
Randomized Controlled Trial

Influence of the timing of administration of crystalloid on maternal hypotension during spinal anesthesia for cesarean delivery: preload versus coload

Ah-Young Oh et al. BMC Anesthesiol. .

Abstract

Background: Prophylactic fluid preloading before spinal anesthesia has been a routine procedure to prevent maternal hypotension during cesarean delivery. Unlike colloid, timing of infusion of crystalloid may be important because of its short stay in intravascular space. We hypothesized that crystalloid loading just after intrathecal injection compared to preload would be more effective in preventing maternal hypotension.

Methods: In this prospective controlled study, sixty parturients were randomized to receive 15 ml/kg of crystalloid before (preload group) or after (coload group) intrathecal drug injection for spinal anesthesia. Hypotension was defined if systolic arterial pressure decreased below 80% of baseline and ephedrine was administered to treat hypotension. The incidence of hypotension and the total dose of ephedrine were checked. Blood pressure, heart rate and nausea before childbirth were assessed. Neonatal outcomes were evaluated with Apgar scores and umbilical blood gas analysis.

Results: The incidence of hypotension was lower in the coload group compared to the preload group (53% vs. 83%, P = 0.026). The blood pressure showed the bigger drop during spinal anesthesia in the preload group (34 ± 13 vs. 25 ± 10 mmHg, P = 0.002) and smaller dose of ephedrine was required in the coload group (7.5 [0-30] vs. 15 [0-40] mg, P = 0.015). The incidence of nausea was also lower in the coload group (27% vs. 60%, P = 0.019). Neonatal outcome measures were comparable between two groups.

Conclusions: In case of using crystalloids for cesarean delivery, coload is more effective than preload for the prevention of maternal hypotension after spinal anesthesia.

Trial registration: Clinical Research Information Service KCT0000324 (Jan 12(th), 2012).

Keywords: Cesarean delivery; Crystalloid; Hypotension; Spinal anesthesia.

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References

    1. Birnbach DJ, Browne IM. In: Miller's Anesthesia. Volume 2. 7. Miller RD, editor. Philadelphia: Elsevier Churchill Livingstone; 2010. Anesthesia for Obstetrics; pp. 2203–2240.
    1. Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev. 2006;4:CD002251. - PubMed
    1. Siddik-Sayyid SM, Nasr VG, Taha SK, Zbeide RA, Shehade JM, Al Alami AA, Mokadem FH, Abdallah FW, Baraka AS, Aouad MT. A randomized trial comparing colloid preload to coload during spinal anesthesia for elective cesarean delivery. Anesth Analg. 2009;109(4):1219–1224. doi: 10.1213/ane.0b013e3181b2bd6b. - DOI - PubMed
    1. Nishikawa K, Yokoyama N, Saito S, Goto F. Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section. J Clin Monit Comput. 2007;21(2):125–129. doi: 10.1007/s10877-006-9066-4. - DOI - PubMed
    1. Teoh WH, Sia AT. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg. 2009;108(5):1592–1598. doi: 10.1213/ane.0b013e31819e016d. - DOI - PubMed

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