Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery

Carvalho, Brendan; Mercier, F.J.; Riley, Edward T.; Brummel, Catherine; Cohen, Sheila E.

doi:10.1016/j.ijoa.2008.12.006

Cited by 48 publications

(55 citation statements)

References 28 publications

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“…We retrieved six manuscripts using the search strategy described. [10][11][12][13][14][15] One of these manuscripts compared a group that received fluid at the time of induction of anesthesia (coload) with a group that received a bolus both before and at the time of induction. 15 This study was omitted from the analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Four of the studies were not blinded [11][12][13]17 and two did not completely describe the randomization process. 10,12 Two of the studies did not describe blinding of allocation.…”

Section: Resultsmentioning

confidence: 99%

“…Hypotension was defined by the authors as a 20% reduction of systolic blood pressure from baseline in five studies, [10][11][12][13]16 a 20% reduction and a systolic blood pressure less than 100 mmHg in one study, 18 and a reduction of 10% in two studies. 14,17 The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (OR 0.93; 95% CI 0.54, 1.6).…”

Section: Incidence Of Hypotensionmentioning

confidence: 99%

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Pré-charge ou co-charge lors de rachianesthésie pour un accouchement non urgent par césarienne: une méta-analyse

Banerjee

Stocche

Angle

et al. 2009

Can J Anesth/J Can Anesth

115

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Background Hypotension following spinal anesthesia for Cesarean delivery is common. Fluid loading is recommended to prevent hypotension, but preload is often ineffective. In non-pregnant patients, coloading has been shown to better maintain cardiac output after spinal anesthesia. The purpose of this meta-analysis was to determine whether the timing of the fluid infusion, before (preload) or during (coload) induction of spinal anesthesia for Cesarean delivery, influences the incidence of maternal hypotension or neonatal outcome. Methods We retrieved randomized controlled trials that compared a fluid preload with coload in patients undergoing spinal anesthesia for elective Cesarean delivery. We graded the articles for quality of reporting (maximum score = 5) and recorded the incidence of hypotension, lowest blood pressure, the incidence of maternal nausea and vomiting, umbilical cord pH, and Apgar scores. We combined the results using random effects modelling. Results We retrieved eight studies comprised of 518 patients. The median quality score for the published studies was three. The incidence of hypotension in the coload group was 159/268 (59.3%) compared with 156/250 (62.4%) in the preload group (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.54-1.6). There were no significant differences between groups in any of the other outcomes. Conclusions It is unnecessary to delay surgery in order to deliver a preload of fluid. Regardless of the fluid loading strategy, the incidence of maternal hypotension is high. Prophylactic or therapeutic vasopressors may be required in a significant proportion of patients. RésuméContexte L'hypotension est un phe´nome`ne courant a`la suite d'une rachianesthe´sie pour un accouchement par ce´sarienne. Il est recommande´d'administrer une charge liquidienne pour pre´venir l'hypotension, mais la pre´-charge est souvent peu efficace. Chez les patients et patientes non enceintes, il a e´te´de´montre´que la co-charge maintenait mieux le de´bit cardiaque apre`s une rachianesthe´sie. L'objectif de cette me´ta-analyse e´tait de de´terminer si le moment de perfusion liquidienne, soit avant (pre´-charge) ou pendant (co-charge) l'induction de la rachianesthe´sie pour un accouchement par ce´sarienne, influençait l'incidence d'hypotension chez la me`re ou le devenir du nouveau-ne´. Méthode Nous avons extrait des e´tudes randomise´es contrôle´es comparant une pre´-charge a`une co-charge liquidienne chez des patientes subissant une rachianesthe´sie pour un accouchement par ce´sarienne non urgent. Nous avons attribue´une note aux articles selon la qualite´de la pre´sentation (score maximal = 5) et note´l'incidence d'hypotension, la tension arte´rielle la plus basse, l'incidence de nause´es et vomissements chez la me`re, le pH du sang du cordon ombilical et les scores d'Apgar. Nous avons combine´les re´sultats a`l'aide d'un mode`le a`effets ale´atoires. 123Can J Anesth/J Can Anesth (2010) 57:24-31 DOI 10.1007 Résultats Nous avons retenu huit e´tudes comprenant 518 patientes. Le score ...

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Section: Resultsmentioning

confidence: 99%

“…Four of the studies were not blinded [11][12][13]17 and two did not completely describe the randomization process. 10,12 Two of the studies did not describe blinding of allocation.…”

Section: Resultsmentioning

confidence: 99%

Section: Incidence Of Hypotensionmentioning

confidence: 99%

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Pré-charge ou co-charge lors de rachianesthésie pour un accouchement non urgent par césarienne: une méta-analyse

Banerjee

Stocche

Angle

et al. 2009

Can J Anesth/J Can Anesth

115

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“…25,[33][34][35] In none of these studies could the investigators demonstrate the superiority of one regimen over another, neither in terms of incidence of maternal hypotension and vasopressor requirement, or in terms of Apgar scores and fetal acid-base balance. In one study, Teoh et al showed that patients who were preloaded with 15 mLÁkg -1 hydroxyethyl starch had a significant increase in cardiac output compared with baseline, but this increase was not maintained ten minutes after spinal anesthesia.…”

Section: Intravascular Volume Loading Strategiesmentioning

confidence: 99%

“…25,[33][34][35] Dans aucune des publications les investigateurs n'ont pu mettre en évidence la supériorité d'une stratégie par rapport à l'autre, tant sur le plan de l'incidence d'hypotension maternelle et des besoins en vasopresseurs que sur le plan des scores d'Apgar et de l'équilibre acido-basique foetal. Tout au plus, Teoh et coll.…”

Section: Le Coremplissage Liquidienunclassified

La prise en charge des liquides et des vasopresseurs pour la césarienne effectuée sous rachianesthésie

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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Techniques for preventing hypotension during spinal anaesthesia for caesarean section

Chooi

Cox

Lumb

et al. 2006

Cochrane Database of Systematic Reviews

257

198

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Hetastarch co-loading is as effective as pre-loading for the prevention of hypotension following spinal anesthesia for cesarean delivery

Cited by 48 publications

References 28 publications

Pré-charge ou co-charge lors de rachianesthésie pour un accouchement non urgent par césarienne: une méta-analyse

Pré-charge ou co-charge lors de rachianesthésie pour un accouchement non urgent par césarienne: une méta-analyse

La prise en charge des liquides et des vasopresseurs pour la césarienne effectuée sous rachianesthésie

Techniques for preventing hypotension during spinal anaesthesia for caesarean section

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