The effect of 0.5 L 6 % hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis

Matsota, Paraskevi; Karakosta, Agathi; Pandazi, Ageliki; Niokou, Dimitra; Christodoulaki, Kalliopi; Kostopanagiotou, Georgia

doi:10.1007/s00540-014-1926-3

Cited by 22 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was also previously demonstrated in previous double blind randomized controlled trials comparing the effect of preload or co-load techniques with HES versus crystalloid for mitigating hypotension due to spinal anesthesia during cesarean delivery [25]. In contrast other studies found significantly different vasopressor use between groups [26, 27]. Explanation for these findings can be related to variability in the amount and concentration of bupivacaine used as well as in study designs and endpoint definitions.…”

Section: Discussionsupporting

confidence: 54%

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

et al. 2016

View full text Add to dashboard Cite

Background Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use. Methods We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group). Results Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intra-operative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group. Conclusions Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.

show abstract

Section: Discussionsupporting

confidence: 54%

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…We included 109 out of 1021 retrieved trials, which included 8561 women (Fig. and see also Supporting Information, Table S1) . Twelve interventions (eleven active treatments and one inactive control) to prevent intra‐operative hypotension were studied, with 30 direct comparisons (see also Supporting Information, Table S2).…”

Section: Resultsmentioning

confidence: 99%

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

et al. 2019

View full text Add to dashboard Cite

Summary Spinal anaesthesia for caesarean section commonly causes maternal hypotension. This systematic review and network meta‐analysis compared methods to prevent hypotension in women receiving spinal anaesthesia for caesarean section. We selected randomised controlled trials that compared an intervention to prevent hypotension with another intervention or inactive control by searching MEDLINE and Embase, Web of Science to December 2018. There was no language restriction. Two reviewers extracted data on trial characteristics, methods and outcomes. We assessed risk of bias for individual trials (Cochrane tool) and quality of evidence (GRADE checklist). We assessed 109 trials (8561 women) and 12 different methods that resulted in 30 direct comparisons. Methods ranked by OR (95%CI) from most effective to least effective were: metaraminol 0.11 (0.04–0.26); norepinephrine 0.13 (0.06–0.28); phenylephrine 0.18 (0.11–0.29); leg compression 0.25 (0.14–0.43); ephedrine 0.28 (0.18–0.43); colloid given before induction of anaesthesia 0.38 (0.24–0.61); angiotensin 2, 0.12 (0.02–0.75); colloid given after induction of anaesthesia 0.52 (0.30–0.90); mephentermine 0.09 (0.01–1.30); crystalloid given after induction of anaesthesia 0.78 (0.46–1.31); and crystalloid given before induction of anaesthesia 1.16 (0.76–1.79). Phenylephrine caused maternal bradycardia compared with control, OR (95%CI) 0.23 (0.07–0.79). Ephedrine lowered umbilical artery pH more than phenylephrine, standardised mean difference (95%CI) 0.78 (0.47–1.49). We conclude that vasopressors should be given to healthy women to prevent hypotension during caesarean section with spinal anaesthesia.

show abstract

“…To prevent hypotension, a number of clinical approaches have been suggested, including volume loading, vasopressor administration and left uterine displacement. When performing spinal anaesthesia for caesarean delivery, it is critically important to identify patients at risk of hypotension, as it would afford anaesthesiologists the opportunity to prevent this phenomenon by taking measures such as pre‐anaesthesia volume expansion and prophylactic vasopressor administration …”

mentioning

confidence: 99%

Pleth variability index can predict spinal anaesthesia‐induced hypotension in patients undergoing caesarean delivery

Kuwata

Suehiro

Juri

et al. 2017

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background: Spinal anaesthesia carries a risk of hypotension. We hypothesized that pleth variability index and perfusion index would assess maternal volume status, and thus, allow identification of patients at higher risk of developing hypotension after spinal anaesthesia for caesarean delivery. Methods: Fifty patients undergoing elective caesarean delivery were enrolled. All patients received spinal anaesthesia with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (10 mcg). Blood pressure was measured every minute. Pleth variability index and perfusion index were automatically measured throughout the procedure using pulse oximetry on the index finger. In case of hypotension (systolic blood pressure below 90 mmHg or 80% of the baseline value), ephedrine 5 mg was administered. Receiveroperating characteristic and multivariate logistic regression analyses for spinal anaesthesia-induced hypotension were performed. Results: Hypotension occurred in 32 patients (64%). The areas under the receiver-operating characteristic curve were 0.751 (95% confidence interval: 0.597-0.904) for pleth variability index before anaesthesia, 0.793 (95% confidence interval: 0.655-0.930) for pleth variability index after anaesthesia and 0.731 (95% confidence interval: 0.570-0.892) for perfusion index change (percent change in perfusion index induced by spinal anaesthesia). The optimal threshold value of pleth variability index (after anaesthesia) for predicting hypotension was 18% (sensitivity: 78.1%, specificity: 83.3%). Pleth variability index after spinal anaesthesia was an independent factor for hypotension (odds ratio: 1.21, P = 0.041). Conclusions: Pleth variability index after spinal anaesthesia was a good predictor of spinal anaesthesia-induced hypotension in patients undergoing caesarean delivery. In addition, perfusion index change after spinal anaesthesia has the potential to predict hypotension.

show abstract

The effect of 0.5 L 6 % hydroxyethyl starch 130/0.42 versus 1 L Ringer’s lactate preload on the hemodynamic status of parturients undergoing spinal anesthesia for elective cesarean delivery using arterial pulse contour analysis

Abstract: Preloading with 0.5 L HES 130/0.42 produced more stable hemodynamics compared to 1 L R/L solution in obstetric patients.

Cited by 22 publications

References 27 publications

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

Effects of hydroxyethyl starch 6 % (130/0.4) on blood loss during cesarean delivery: a propensity-matched analysis

Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta‐analysis of randomised controlled trials

Pleth variability index can predict spinal anaesthesia‐induced hypotension in patients undergoing caesarean delivery

Contact Info

Product

Resources

About