Effects of colloid preload on the incidence of hypotension in spinal anesthesia for cesarean section: a systematic review and meta-analysis

Abstract

Background:Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.Methods:Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.Results:Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.Conclusion:This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Preliminary study on fluid bolus administration for prevention of spinal hypotension in dogs undergoing elective cesarean section

“…On the other hand, some authors noted that patients with colloid preload had fewer episodes of low blood pressure than those patients with colloid coloads ( 21 , 22 ). In other studies, both groups were similarly hypotensive ( 23 – 27 ). In summary, in human medicine there is still no consensus on the type of fluid and its loading time in patients undergoing EA or regarding the total fluid and dosing rate in preventing epidural hypotension.…”

The Management of Spinal and Epidural Anesthesia-Related Hypotension in the United States During Cesarean Childbirth

“…Current researchers have investigated the administration of colloid preload during neuraxial (spinal) anesthesia to see how well it can reduce the risk of hypotension during cesarean sections [ 5 ]. Gong et al found after analyzing 831 patients in a total of nine studies, that there were no significant differences in hypotension between those who received colloid preload and the control group [ 5 ]. The researchers also found that hypotension occurring during spinal anesthesia is an important factor in intra-operative nausea and vomiting due to gut ischemia and serotonin release.…”

“…The researchers also found that hypotension occurring during spinal anesthesia is an important factor in intra-operative nausea and vomiting due to gut ischemia and serotonin release. However, there were no significant differences in hypotension levels compared to the control group when colloid was administered [ 5 ]. Additionally, when analyzing volume therapy, a rapid crystalloid co-loading is more effective in reducing the incidence of hypotension than a crystalloid preload [ 6 ].…”

Esketamine Combined with Dexmedetomidine to reduce Visceral Pain During elective Cesarean Section Under Combined Spinal-Epidural Anesthesia: A double-Blind Randomized Controlled Study

“…34 Hypotension often occurs after neuraxial anesthesia during cesarean section and may lead to poor prognosis for both the parturients and fetus in severe cases. 35 In theory, esketamine has a sympathetic nerve stimulating effect, 36 which can increase the heart rate and blood pressure. Therefore, it may not be suitable for Patients with gestational hypertension, preeclampsia, or eclampsia.…”