Comparison of effects of rapid colloid loading before and after spinal anesthesia on maternal hemodynamics and neonatal outcomes in cesarean section |
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Authors: | Koichi Nishikawa Naho Yokoyama Shigeru Saito Fumio Goto |
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Institution: | (1) Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi City 371-8511, Japan |
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Abstract: | Background The effects of colloid loading after spinal anesthesia on hemodynamics in parturients during cesarean section have not been
fully understood. This study tested the hypothesis that colloid loading after spinal blockade can reduce hypotension compared
with preloading, and affect neonatal outcomes.
Methods A prospective, randomized, double-blinded study was performed in 54 healthy parturients (ASA I or II) undergoing elective
cesarean section. Patients were randomly allocated into one of three groups to receive rapid infusion of 6% hydroxyethylstarch
(HES) (70 kDa/0.5) before spinal anesthesia (15 ml·kg−1, HES preload group, n = 18), or rapid infusion of HES after induction of spinal anesthesia (15 ml·kg−1, HES coload group, n = 18), or no rapid infusion (control, n = 18). The incidence of hypotension, and the amount of ephedrine used to treat hypotension was compared. Neonatal outcomes
were also assessed by pH, base excess, lactate concentration, and Apgar scores.
Results The incidence of hypotension was significantly lower in HES preload and HES coload groups than control group (P < 0.01). Although systolic blood pressure decreased after spinal blockade in all groups, the lowest SBP after spinal blockade
until delivery was significantly higher in fluid loading groups than control (P < 0.001). Similarly, total dose of ephedrine to treat hypotension was lower in fluid loading groups (P < 0.001). Umbilical cord pH, umbilical lactate concentration, and the incidence of neonates with Apgar score <7 were similar.
Conclusion Colloid loading after induction of spinal anesthesia was similarly effective in reducing hypo- tension compared with preloading
in cesarean section.
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.
A part of the present study was presented at the Annual Meeting of the American Society of Anesthesiologists, October 23–27,
2004 in Las Vegas, Nevada, USA. |
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Keywords: | Ringer’ s solution fetal acidosis colloid lactate concentration volume coload |
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