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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.
Int J Obstet Anesth 2007; 16(1):8-12IJ

Abstract

BACKGROUND

Spinal anesthesia for cesarean delivery is commonly associated with hypotension and nausea and vomiting, and preload with crystalloid or colloid solution is widely recommended. Low-dose spinal via the combined spinal-epidural technique appears to cause less hypotension and nausea and vomiting. The aim of this study was to investigate whether the combined use of colloid preload and combined spinal-epidural technique might further reduce the rates of these symptoms.

METHODS

Women undergoing elective cesarean delivery were randomly allocated to one of four groups (50 in each) to receive crystalloid preload before spinal anesthesia, colloid preload before spinal anesthesia, crystalloid preload before combined spinal-epidural anesthesia, and colloid preload before combined spinal-epidural anesthesia. The incidences of hypotension and nausea and vomiting were compared. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine 9 mg and fentanyl 20 microg, and combined spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine 6 mg + fentanyl 20 microg followed by epidural injection of 0.25% bupivacaine 10 mL.

RESULTS

The frequencies of hypotension were 44%, 18%, 24%, and 20% in crystalloid preload-spinal anesthesia, colloid preload-spinal anesthesia, crystalloid preload-combined spinal epidural anesthesia, and colloid preload-combined spinal epidural anesthesia groups, respectively. The frequencies of nausea and vomiting were 20%, 2%, 8%, and 4% in respective groups.

CONCLUSION

Colloid preload and low-dose spinal anesthesia alone or in combination lowered the incidences of hypotension and nausea. However, the combination of two methods failed to demonstrate further decreases in the incidence of the symptoms compared to the colloid-spinal anesthesia or crystalloid-combined spinal-epidural anesthesia groups.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17125995

Citation

Ko, J-S, et al. "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." International Journal of Obstetric Anesthesia, vol. 16, no. 1, 2007, pp. 8-12.
Ko JS, Kim CS, Cho HS, et al. 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. Int J Obstet Anesth. 2007;16(1):8-12.
Ko, J. S., Kim, C. S., Cho, H. S., & Choi, D. H. (2007). 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. International Journal of Obstetric Anesthesia, 16(1), pp. 8-12.
Ko JS, et al. 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. Int J Obstet Anesth. 2007;16(1):8-12. PubMed PMID: 17125995.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Ko,J-S, AU - Kim,C-S, AU - Cho,H-S, AU - Choi,D-H, Y1 - 2006/11/27/ PY - 2006/04/01/received PY - 2006/07/01/accepted PY - 2006/11/28/pubmed PY - 2007/4/24/medline PY - 2006/11/28/entrez SP - 8 EP - 12 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 16 IS - 1 N2 - BACKGROUND: Spinal anesthesia for cesarean delivery is commonly associated with hypotension and nausea and vomiting, and preload with crystalloid or colloid solution is widely recommended. Low-dose spinal via the combined spinal-epidural technique appears to cause less hypotension and nausea and vomiting. The aim of this study was to investigate whether the combined use of colloid preload and combined spinal-epidural technique might further reduce the rates of these symptoms. METHODS: Women undergoing elective cesarean delivery were randomly allocated to one of four groups (50 in each) to receive crystalloid preload before spinal anesthesia, colloid preload before spinal anesthesia, crystalloid preload before combined spinal-epidural anesthesia, and colloid preload before combined spinal-epidural anesthesia. The incidences of hypotension and nausea and vomiting were compared. Spinal anesthesia was performed with 0.5% hyperbaric bupivacaine 9 mg and fentanyl 20 microg, and combined spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine 6 mg + fentanyl 20 microg followed by epidural injection of 0.25% bupivacaine 10 mL. RESULTS: The frequencies of hypotension were 44%, 18%, 24%, and 20% in crystalloid preload-spinal anesthesia, colloid preload-spinal anesthesia, crystalloid preload-combined spinal epidural anesthesia, and colloid preload-combined spinal epidural anesthesia groups, respectively. The frequencies of nausea and vomiting were 20%, 2%, 8%, and 4% in respective groups. CONCLUSION: Colloid preload and low-dose spinal anesthesia alone or in combination lowered the incidences of hypotension and nausea. However, the combination of two methods failed to demonstrate further decreases in the incidence of the symptoms compared to the colloid-spinal anesthesia or crystalloid-combined spinal-epidural anesthesia groups. SN - 0959-289X UR - https://www.unboundmedicine.com/medline/citation/17125995/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(06)00135-X DB - PRIME DP - Unbound Medicine ER -