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Prediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload.
Int J Obstet Anesth 2007; 16(2):128-34IJ

Abstract

BACKGROUND

If parturients prone to develop caval compression in the supine position were identified before delivery, this might be a method of predicting hypotension during caesarean section under spinal anesthesia. Colloid preloading is superior to crystalloid in reducing the risk for spinal anesthetic-induced hypotension. It is postulated that parturients preoperatively susceptible to the supine position would benefit the most from colloid preloading.

METHODS

Fifty-five healthy parturients scheduled for elective cesarean section under spinal anesthesia were preoperatively investigated with a supine stress test with measurement of maternal heart rate, blood pressure, right uterine artery pulsatility index and symptoms in the left lateral and supine positions. They were then randomized to receive a colloid or crystalloid preload before anesthesia.

RESULTS

The stress test was positive, indicating a reduced tolerance to the supine position, in 36%. The sensitivity and specificity of the stress test for clinically significant hypotension (symptomatic hypotension) for patients randomized to the crystalloid group (n=25) were 69 and 92% respectively. Patients with a positive stress test receiving a crystalloid preload showed a higher frequency of hypotension compared to all other groups, 90% vs. 33%, (P=0.003) and also a greater need for ephedrine, mean dose (SD): 20.0 (9.7) vs. 8.4 (9.0) mg (P=0.002).

CONCLUSIONS

Pregnant women with a positive preoperative supine stress test constitute a subset at increased risk for clinically significant hypotension during cesarean delivery under spinal anesthesia. These women seem more likely to benefit from prophylactic colloid solution than women with a negative stress test.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. gunnar.dahlgren@karolinska.seNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17276668

Citation

Dahlgren, G, et al. "Prediction of Hypotension During Spinal Anesthesia for Cesarean Section and Its Relation to the Effect of Crystalloid or Colloid Preload." International Journal of Obstetric Anesthesia, vol. 16, no. 2, 2007, pp. 128-34.
Dahlgren G, Granath F, Wessel H, et al. Prediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload. Int J Obstet Anesth. 2007;16(2):128-34.
Dahlgren, G., Granath, F., Wessel, H., & Irestedt, L. (2007). Prediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload. International Journal of Obstetric Anesthesia, 16(2), pp. 128-34.
Dahlgren G, et al. Prediction of Hypotension During Spinal Anesthesia for Cesarean Section and Its Relation to the Effect of Crystalloid or Colloid Preload. Int J Obstet Anesth. 2007;16(2):128-34. PubMed PMID: 17276668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of hypotension during spinal anesthesia for Cesarean section and its relation to the effect of crystalloid or colloid preload. AU - Dahlgren,G, AU - Granath,F, AU - Wessel,H, AU - Irestedt,L, Y1 - 2007/02/05/ PY - 2006/06/01/received PY - 2006/07/01/revised PY - 2006/10/01/accepted PY - 2007/2/6/pubmed PY - 2007/7/13/medline PY - 2007/2/6/entrez SP - 128 EP - 34 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 16 IS - 2 N2 - BACKGROUND: If parturients prone to develop caval compression in the supine position were identified before delivery, this might be a method of predicting hypotension during caesarean section under spinal anesthesia. Colloid preloading is superior to crystalloid in reducing the risk for spinal anesthetic-induced hypotension. It is postulated that parturients preoperatively susceptible to the supine position would benefit the most from colloid preloading. METHODS: Fifty-five healthy parturients scheduled for elective cesarean section under spinal anesthesia were preoperatively investigated with a supine stress test with measurement of maternal heart rate, blood pressure, right uterine artery pulsatility index and symptoms in the left lateral and supine positions. They were then randomized to receive a colloid or crystalloid preload before anesthesia. RESULTS: The stress test was positive, indicating a reduced tolerance to the supine position, in 36%. The sensitivity and specificity of the stress test for clinically significant hypotension (symptomatic hypotension) for patients randomized to the crystalloid group (n=25) were 69 and 92% respectively. Patients with a positive stress test receiving a crystalloid preload showed a higher frequency of hypotension compared to all other groups, 90% vs. 33%, (P=0.003) and also a greater need for ephedrine, mean dose (SD): 20.0 (9.7) vs. 8.4 (9.0) mg (P=0.002). CONCLUSIONS: Pregnant women with a positive preoperative supine stress test constitute a subset at increased risk for clinically significant hypotension during cesarean delivery under spinal anesthesia. These women seem more likely to benefit from prophylactic colloid solution than women with a negative stress test. SN - 0959-289X UR - https://www.unboundmedicine.com/medline/citation/17276668/Prediction_of_hypotension_during_spinal_anesthesia_for_Cesarean_section_and_its_relation_to_the_effect_of_crystalloid_or_colloid_preload_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0959-289X(06)00203-2 DB - PRIME DP - Unbound Medicine ER -