Comparison between colloid preload and crystalloid co-load in cesarean section under spinal anesthesia: a randomized controlled trial |
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| Affiliation: | 1. Department of Anesthesia and Surgical Intensive Care, Mansoura University Hospitals, Mansoura, Egypt;2. Department of Obstetrics and Gynecology, Mansoura University Hospitals, Mansoura, Egypt;1. University Hospital of Tours, Department of Anaesthesiology and Intensive Care, Hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France;2. University Hospital of Messina, Department of Human Pathology, Via Consolare Valeria, 1, 98125 Messina, Italy;1. Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland;2. Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands;3. Department of Anesthesiology, Sidra Medicine, Doha, Qatar;4. Department of Anaesthesia, University Hospital RWTH Aachen, Aachen, Germany;1. Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, USA;2. Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA |
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| Abstract: | BackgroundHypotension is a common problem during spinal anesthesia for cesarean delivery. Intravenous fluid loading is used to correct preoperative dehydration and reduce the incidence and severity of hypotension. Different fluid regimens have been studied but colloid preload and crystalloid co-load have not been compared.MethodsIn this randomized double-blind study, 210 patients scheduled for elective cesarean section under spinal anesthesia were randomly allocated to receive either 6% hydroxyethyl starch 130/0.4 500 mL before spinal anesthesia (colloid preload) or Ringer’s acetate solution 1000 mL administered rapidly starting with intrathecal injection (crystalloid co-load). Maternal hypotension (systolic blood pressure <80% of baseline or <90 mmHg) and severe hypotension (systolic blood pressure <80 mmHg) were treated with 5 and 10 mg ephedrine boluses, respectively. The primary outcome was the incidence of hypotension. Secondary outcomes included the incidence of severe hypotension, total ephedrine dose, nausea and vomiting and neonatal outcome assessed by Apgar scores and umbilical artery blood gas analysis.ResultsData analysis was performed on 205 patients; 103 in the colloid preload group and 102 in the crystalloid co-load group. There were no significant differences in the incidence of hypotension (52.4% vs. 42.2%; P=0.18) or severe hypotension (15.5% vs. 9.8%; P=0.31) between colloid preload and crystalloid co-load groups, respectively. The median [range] ephedrine dose was 5 [0–45] mg in the colloid preload group and 0 [0–35] mg in the crystalloid co-load group (P=0.065). There were no significant differences in maternal nausea or vomiting or neonatal outcomes between groups.ConclusionThe use of 1000 mL crystalloid co-load has similar effect to 500 mL colloid preload in reducing the incidence of hypotension after spinal anesthesia for elective cesarean delivery. Neither technique can totally prevent hypotension and should be combined with vasopressor use. |
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| Keywords: | Cesarean section Spinal anesthesia Hypotension Intravenous fluids Preload Co-load |
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