A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery

Ko, JS; Kim, Chang Sung; Hs, Cho; Choi, Dong‐Hee

doi:10.1016/j.ijoa.2006.07.004

Cited by 57 publications

(29 citation statements)

References 31 publications

(34 reference statements)

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“…1 This has been attributed in part to local anesthetic-induced sympathectomy and in part to aortocaval compression caused by the gravid uterus. Several strategies, including uterine displacement, 2 lower legs compression, 3 and the administration of fluids 4 and vasopressors, 5 have been shown to decrease the occurrence of this hypotension; however, none has been shown to eliminate the need to treat it. 6 In contrast, patient position has had variable effects on the incidence of hypotension after spinal anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

El-Hakeem

Kaki

Almazrooa

et al. 2011

Can J Anesth/J Can Anesth

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Background Patient position after spinal anesthesia has had variable effects on blood pressure and ephedrine requirements. The aim of this study was to determine the effects that sitting the patient up for five minutes after spinal anesthesia would have on intraoperative fluid and ephedrine requirements. Methods The study included 120 women at term gestation who were scheduled for Cesarean delivery under spinal anesthesia. After anesthetic administration, the women were randomized either to sit up for five minutes then lie down (Group S) or to lie down immediately (Group L) to a tilted supine position. A blinded observer recorded sensory block level, systolic blood pressure, heart rate, ephedrine and fluid requirements, adverse events, and time to motor recovery (modified Bromage score of 2). Results Group S had a lower intraoperative sensory block height than Group L [T4 (1) vs T2 (1), respectively; P \ 0.001]; Group S also required less ephedrine (8% vs 47%, respectively; P \ 0.001), received less fluid [709 (59) mL vs 789 (90) mL, respectively; P \ 0.001], and experienced less nausea and vomiting (5% vs 22%, respectively; P = 0.014) and shortness of breath (3% vs 28%, respectively; P \ 0.001) intraoperatively. In Group S, the odds of requiring ephedrine were 0.09 compared with 0.89 in Group L (odds ratio 0.10). There were no differences in systolic blood pressure (P = 0.127) or heart rate (P = 0.831) over time between groups. Time to a modified Bromage score of 2 was longer in Group S than in Group L [101 (15) min vs 88 (14) min, respectively; P \ 0.001]. Conclusions Sitting the patient up for five minutes rather than laying the patient down immediately after spinal anesthesia for Cesarean delivery decreased intraoperative sensory block height, ephedrine and fluid requirements, and intraoperative nausea, vomiting, and shortness of breath without affecting systolic blood pressure or the success of the anesthetic. However, the method resulted in delayed postoperative motor recovery. RésuméContexte Il a e´te´de´montre´que la position du patient a`la suite d'une rachianesthe´sie a des effets variables sur la Authorship contributions Drs. Essam E. Abd El-Hakeem, Abdullah M. Kaki, and Adnan A. Almazrooa contributed to the conception and design of the study and to acquisition of the data and its interpretation. Dr. Nisma M. Al-Mansouri made substantial contribution to the recruitment of patients, acquisition of data, and obtaining the necessary references. She helped draft the manuscript and approved its final submitted version. Dr. Jamal A. Alhashemi performed the statistical analysis and he made substantial contribution to the interpretation of the data, drafting the manuscript and revising it for important intellectual content.

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Section: Introductionmentioning

confidence: 99%

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

El-Hakeem

Kaki

Almazrooa

et al. 2011

Can J Anesth/J Can Anesth

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“…20,24 Colloid preload (regimen II) Usually, colloid preloading appears to be effective in preventing arterial hypotension and maintaining maternal cardiac output, compared with crystalloid preloading or no preloading at all. 7,11,18,[25][26][27][28][29] Siddik et al showed that giving a volume of 500 mL of hydroxyethyl starch decreased hypotension, the requirement for vasopressors, and the incidence of nausea and vomiting, compared with 1,000 mL of Ringer's lactate. 28 In a study by Dahlgren et al, patients who received 1,000 mL of 3% dextran had fewer hypotensive episodes associated with nausea and vomiting.…”

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 99%

“…7,11,18,[25][26][27][28][29] Siddik et coll. ont démontré que l'administration d'un volume de 500 mL d'hydroxyéthylamidon réduisait l'incidence d'hypotension, les besoins en vasopresseurs et l'incidence de nausées et vomissements comparativement à un volume de 1,000 mL de lactate Ringer.…”

Section: Les Stratégies De Remplissage Vasculaireunclassified

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Loubert

2012

Can J Anesth/J Can Anesth

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Purpose The purpose of this Continuing Professional Development module is to review the physiology of maternal hypotension induced by spinal anesthesia in pregnant women, and the effects of fluids and vasopressors. Principal findings Maternal hypotension induced by spinal anesthesia is caused mainly by peripheral vasodilatation and is not usually associated with a decrease in cardiac output. Although the intravenous administration of fluids helps to increase cardiac output, it does not always prevent maternal hypotension. Three strategies of fluid administrations are equivalent for the prevention of maternal hypotension and a reduced need for vasopressors: (1) colloid preload; (2) colloid coload; and (3) crystalloid coload. Crystalloid preload is not as effective as any of those three strategies. Unlike phenylephrine, ephedrine can cause fetal acidosis. Therefore, phenylephrine is recommended as first line treatment of maternal hypotension. A phenylephrine infusion (25-50 lgÁmin -1 ) appears to be more effective than phenylephrine boluses to prevent hypotension, and nausea and vomiting. In preeclamptic patients, spinal anesthesia produces less hypotension than in normal pregnant women and fluid volumes up to 1,000 mL are usually well tolerated. Therefore mild to moderate intravascular volume loading is recommended, keeping in mind the increased risk for pulmonary edema in this population. In pre-eclamptic patients, hypotension can be treated either with ephedrine or phenylephrine, and phenylephrine infusions are not recommended.Conclusion A volume loading regimen other than crystalloid preload should be adopted. A phenylephrine infusion during elective Cesarean delivery is beneficial for the mother and safe for the newborn. Objectives of this Continuing Professional Development (CPD) module:After reading this module, the reader should be able to:1. Describe the main hemodynamic changes induced by spinal anesthesia in a pregnant woman undergoing a scheduled Cesarean delivery. 2. Recognize the clinical implications of those hemodynamic changes in the mother and fetus. 3. Explain the various strategies of vascular loading, and their main hemodynamic repercussions. 4. Assess the impact of using phenylephrine and ephedrine for the prevention and treatment of maternal hypotension. 5. Plan the fluid and vasopressor therapy in the case of an urgent Cesarean delivery.The increased popularity of regional anesthesia in clinical practice has led to a decrease in maternal mortality and morbidity related to complications in airway management. Spinal anesthesia is now the most popular technique for Cesarean delivery as it is easy to perform and provides a rapid onset, dense surgical block. It is not associated with a maternal or fetal risk of toxicity to local anesthetics. However, spinal anesthesia is often associated with significant maternal hypotension, with potentially significant consequences on maternal comfort, organ perfusion, and fetal well-being. Several studies suggest that the traditional approach that con...

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“…[3] With the recent focus is on the timing of fluid bolus (preload or coload) and the viability of colloids, we chose to compare the relative efficacy of colloid preload versus coload in reduction of hypotension during cesarean delivery, under the settings of low dose spinal anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Comparison of colloid preload versus coload under low dose spinal anesthesia for cesarean delivery

Varshney¹,

Jain²

2013

Anesth Essays Res

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Background:Although fluid bolus is considered as a conventional prophylactic measure to prevent spinal-induced hypotension; vasopressors are nevertheless required. Low dose spinal anesthetics could markedly reduce such episodes of hypotension, by minimizing sympathetic blockade.Aims:We chose to compare the relative efficacy of colloid preload versus coload under low dose spinal anesthesia, for elective cesarean delivery.Settings and Design:A prospective, randomized, double-blinded study.Materials and Methods:In total, 42 parturients were randomized to receive a preload (Group P) of hydroxyl ethyl starch (10 ml/kg) over 20 min before initiation of low dose spinal anesthesia (hyperbaric bupivacaine 5.5 mg with fentanyl 25 μg) or coload (Group C) of an identical fluid over 5 min, starting at the time of identification of cerebrospinal fluid. Our primary outcome included hemodynamic parameters and the incidence of hypotension. The neonatal outcome and side-effects were also monitored.Statistical Analysis:Mann-Whitney U test and Fisher's exact/Chi-square test, whichever appropriate. A P < 0.05 was considered to be significant.Results:The incidence of hypotension was lower in Group P (10%) when compared with Group C (25%), though insignificant statistically. The hemodynamic parameters were better in Group P, though intergroup statistical differences were not observed. The time to the first episode of hypotension was longer in the Group P (17 min) as compared with Group C (14 min). No notable side-effects or adverse neonatal outcome was noted.Conclusion:Colloid preload has a clinical advantage over the coload strategy, in reducing hypotensive episodes under low dose spinal anesthesia. Preload is better under large hemodynamic fluctuations while coload is preferable for emergency scenarios.

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A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery

Cited by 57 publications

References 31 publications

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

Effects of sitting up for five minutes versus immediately lying down after spinal anesthesia for Cesarean delivery on fluid and ephedrine requirement; a randomized trial

Fluid and vasopressor management for Cesarean delivery under spinal anesthesia: Continuing Professional Development

Comparison of colloid preload versus coload under low dose spinal anesthesia for cesarean delivery

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